Compounds and methods for treating an epileptic disorder

ABSTRACT

Provided, inter alia, are methods for treating an epilepsy disorder using clemizole, a clemizole analog, or pharmaceutical salts thereof.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation of International ApplicationPCT/US2014/051731, filed Aug. 19, 2014, which claims the benefit of U.S.Provisional Application No. 61/867,397, filed Aug. 19, 2013, each ofwhich is hereby incorporated by reference in its entirety for allpurposes.

STATEMENT AS TO RIGHTS TO INVENTIONS MADE UNDER FEDERALLY SPONSOREDRESEARCH AND DEVELOPMENT

This invention was made with Government support under grant number R01NS079214 03 awarded by the National Institutes of Health. The Governmenthas certain rights in the invention.

REFERENCE TO A “SEQUENCE LISTING,” A TABLE, OR A COMPUTER PROGRAMLISTING APPENDIX SUBMITTED AS AN ASCII FILE

The Sequence Listing written in file 48536_545N01US_ST25.TXT, createdMay 4, 2016, 1,114 bytes, machine format IBM-PC, MS-Windows operatingsystem, is hereby incorporated by reference.

BACKGROUND OF THE INVENTION

Dravet syndrome (DS) is a catastrophic pediatric epilepsy with severeintellectual disability, impaired social development and persistentdrug-resistant seizures. One of its primary causes is mutations inNav1.1 (SCN1A), a voltage-gated sodium channel. Seizures experienced bythose with DS and other epilepsy disorders are inadequately managedusing available antiepileptic drugs (AEDs) and children with DS are poorcandidates for neurosurgical resection. Thus there is a need in the artfor epilepsy treatment options, especially those for DS and relatedcatastrophic pediatric epilepsies. Provided herein are solutions tothese problems and other problems in the art.

BRIEF SUMMARY OF THE INVENTION

Provided herein, inter alia, are methods of treating epilepsy disordersusing clemizole, a clemizole analog, or a pharmaceutically acceptablesalt thereof. In one aspect the method includes administering to asubject in need thereof, a therapeutically effective amount ofclemizole, a clemizole analog, or a pharmaceutically acceptable saltthereof. In another aspect the method includes administering to asubject in need thereof, a pharmaceutical composition that includes atherapeutically effective amount of clemizole, a clemizole analog, or apharmaceutically acceptable salt thereof.

Further provided herein are pharmaceutical compositions for treatingepilepsy disorders. In one aspect is a pharmaceutical composition thatincludes clemizole, a clemizole analog, or a pharmaceutically acceptablesalt thereof for use in treating an epilepsy disorder.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-1E. Molecular characterization of scn1Lab zebrafish mutants.(FIG. 1A) Sequencing confirmed a T-to-G mutation in scn1Lab mutant cDNA.Sequence legend: FMILL (SEQ ID NO:1); TTCATGATTTTACTC (SEQ ID NO:2);FRILL (SEQ ID NO:3); TTCAGGATTTTACTC (SEQ ID NO:4). (FIG. 1B)Verification of reduced expression in scn1Lab mutants compared tosibling controls at 3, 5 and 7 dpf using qPCR. Data presented asmean±S.E.M; *significance taken as p<0.05 student's t-test. Data werenormalized to internal reference gene β-actin. Values represent averagesfrom five independent biological samples (1 sample=10 pooled larvae) foreach of the 3 developmental stages. Data presented as mean±S.E.M;*significance taken as p<0.05 student's t-test. (FIG. 1C) Relativeexpression of scn8aa and scn8ab in Na_(v)1.1 mutants (n=5) and siblingcontrols (n=5) at 5 dpf. Data presented as in B. (FIG. 1D) Whole-mountin situ hybridization for scn1Lab in larval zebrafish at 3, 5 and 7 dpf.Wild-type larvae are shown in lateral views; expression is shown in darkpurple. Scn1Laa expression at 3 dpf is shown for comparison. Heartindicated by arrowheads in 5 and 7 dpf panels. (FIG. 1E) Dorsal view ofscb1Laa expression at 3 dpf; note prominent expression in regionscorresponding to the larval zebrafish CNS. Abbreviations: Tel,telencephalon; TeO, optic tectum; Cb, cerebellum. Scale bars=0.35 mm inD, 0.2 mm in E.

FIGS. 2A-2C. Microarray analysis of scn1Lab zebrafish mutants. (FIG. 2A)Heat maps depicting the expression of genes differentially expressedbetween scn1Lab mutant and sibling control larvae at 5 dpf. Rowsrepresent individual genes. Columns represent different larvae. Genesthat are highly expressed in scn1Lab mutants relative to controls are asshown. (FIG. 2B) MA plot of normalized microarray data for all 44,000genes. The log-ratio M and the mean fluorescence intensity A werecalculated as the averages for all replicates. (FIG. 2C) A list of thetop 30 genes showing the greatest differences in expression betweenscn1Lab mutants and sibling controls.

FIGS. 3A-3C. Quantitative RT-PCR analysis of scn1Lab zebrafish mutants.(FIG. 3A) Comparison of the gene expression fold changes obtained bymicroarray analysis (array) and real-time qPCR analysis. The y-axisrepresents the average fold change in gene expression of each gene fromzebrafish at 5 dpf. The x-axis represents different genes. (FIG. 3B)qPCR analysis of three genes involved in epileptogenesis. The relativegene expression is presented as log₂ ratios to the least abundanttranscript (log₂ΔΔct). Data were normalized to internal reference geneβ-actin. Values represent averages from five independent biologicalsamples (1 sample 10 pooled larvae). Bars indicate S.E.M; *p<0.05t-test. (FIG. 3C) Gene ontology classification of differentiallyexpressed genes detected in scn1Lab mutants at 5 dpf (p<0.05 ANOVAone-way and fold changes >1.5). Biological processes representing atleast 5 gene annotations in at least one category are displayed.

FIGS. 4A-4C. Spontaneous seizures in scn1Lab zebrafish mutants. (FIG.4A) Immobilized and agar-embedded zebrafish larvae are shown. Imageswere obtained using a 4× objective and 2× magnifier on an Olympusupright microscope during forebrain electrophysiological recordings insibling control (FIG. 4A, left) and scn1Lab mutant (FIG. 4A, middle)larvae at 5 dpf. Note the dark pigmentation for mutants. Recordingelectrodes can be seen in panels A1-2 and the approximate site of therecording electrode tip in the forebrain (red circle) is shown using arepresentative HuC:GFP labeled larvae in FIG. 4A, right. Scale bar: 100μm. (FIG. 4B) Sample locomotion tracking plot for sibling control (FIG.4B, left) and scn1Lab mutant (FIG. 4B, right) larvae at 5 dpf. (FIG. 4C)Representative 10 min recording epochs obtained in the forebrain ofparalyzed, immobilized and agar-embedded scn1Lab mutant larvae between 3and 7 dpf. Note the presence of small and large amplitude spontaneousburst discharge; additional temporal expansions of seizure activity. Arepresentative recording, under identical recording conditions, from asibling control larvae at 5 dpf is also shown. Scale bar: 2 mV; 30 sec.

FIGS. 5A-5F. Pharmacological validation of scn1Lab zebrafish mutants.(FIG. 5A) Heat map showing the response to nine different AEDs. Eachcolumn represents the percent change in burst frequency(baseline−drug/baseline×100) for one individual zebrafish mutant. Drugsthat inhibit seizure events are shown in dark blue. All drugs weretested at a concentration of 1 mM. Note in some trials carbamazepine andvigabatrin increased burst frequency over the initial baseline levels.(FIG. 5B) Plot of the mean change in burst frequency and standard errorfor the data shown in the heat map. Paired t-test or Wilcoxon signedrank sum test for data that failed the normality test showedsignificance as follows: diazepam (p=0.002; n=7), potassium bromide(p=0.016; n=7), stiripentol (p=0.024; n=7), and valproate (p=0.004;n=7). (FIG. 5C) Plot of the burst duration for all trials shown in FIG.5A. Data is presented as the mean±S.E.M. for electrographic seizureevents at baseline (black bars) and after drug exposure (white bars).Inset shows a representative 2 min recording during the stiripentoltrial; scale bars: large trace 1 mV, 1 sec; small trace, 1 mV, 100 msec.(FIG. 5D) Plot of the fractional time spent seizing for all trials shownin FIG. 5A. Data is presented as the mean±S.E.M. for electrographicseizure events at baseline (black bars) and after drug exposure (whitebars). Student's t-test or Mann-Whitney-Rank sum test for data thatfailed the normality test showed significance as follows: diazepam(p=0.001; n=7); potassium bromide (p=0.043; n=7); stiripentol (p=0.007;n=7) and valproate (p=0.007; n=7 (FIG. 5E) Locomotion tracking plots for10 individual mutant larvae raised in embryo media (top row) or theketogenic diet for 48 hr. Plots show swim velocity and locomotion trackswith darker colors indicative of higher velocities; 10 min trials areshown. (FIG. 5F) Representative 10 min extracellular recording epochsfrom the same fish shown in E; representative examples are indicated byan * in the locomotion plots. Scale bar: 1 mV, 30 sec. Inset shows burstat higher temporal resolution (indicated by #); scale bar: 1 mV, 100msec.

FIGS. 6A-6E. A screen to identify drugs that rescue the scn1Lab mutantepilepsy phenotype. (FIG. 6A) Box plot of mean velocity (in mm/sec) fortwo consecutive recordings of mutant larvae in embryo media. Theexperiments were performed by first placing the mutant larvae in embryomedia and obtaining a baseline locomotion response, embryo media wasthen replaced with new embryo media (to mimic the procedure used fortest compounds) and a second locomotion response was obtained. Thepercent change in velocity from baseline (recording #1) vs. experimental(recording #2) is shown. In the boxplot, the bottom and top of the boxrepresent the 25th percentile and the 75th percentile, respectively. Theline across the box represents the median value, and the vertical linesencompass the entire range of values. This plot represents normalchanges in tracking activity in the absence of a drug challenge. (FIG.6B) Plot of the effect of eleven known antiepileptic drugs on locomotorseizure behavior in scn1Lab mutants at 5 dpf. Phenotype-based assay wasperformed in a 96-well format (for example, see panel FIG. 5C1). Barsrepresent the percent change in mean velocity comparing a baselinerecording of mutant seizure activity with the same mutant after a drugapplication. For all drug studies 6-12 fish were used per experiment.Drugs were tested at a concentration of 1 mM; diazepam (Dzp; p<0.001),carbamazepine (Carb, p=0.024), ganaxolone (Gan; p=0.003), stiripentol(Stp; p=0.001), valproate (Vpa, p=0.026) and a 48 hr exposure to theketogenic diet (KD; p=0.003) reduced seizure activity, measured as achange in velocity, by more than 34% (dotted line in B; represents afold-change greater than the standard deviation in control recordings).Acetazolamide (Acet, p<0.001) and ethosuximide (Etx; p=0.250) increasedseizure behavior; levetiracetam (Lev; p=0.243), and lamotrigine (Ltg;p=0.058) had no effect. (FIG. 6C) Plot of locomotor seizure behavior forscn1Laab mutants at 5 dpf for the 320 compounds tested. Colored circlesrepresent positive hits; compounds that decreased activity by 100% weregenerally toxic; 6-12 fish per trial. Arrowhead denotes the firstclemizole trial. Note some compounds increased seizure activity, asexpected. (FIG. 6D) Plot of drug re-trials on separate clutches ofscn1Lab mutants at 5 dpf; 100 μM per drug; 10 fish per trial.Abbreviations: Clem, clemizole; Clem+PTZ, clemizole+15 mM PTZ; Clorg,clorgiline; Tolp, tolperisone; Zox, zoxazolamine. Effect of acuteclemizole on PTZ-induced seizure behavior is shown for wild-type larvae.Bars represent mean±S.E.M. For panels FIG. 6B and FIG. 6D: Student'spaired t-test or Mann-Whitney Rank Sum test with significance set atp=0.01 (*) or p<0.001 (**). (FIG. 6E) Sample electrophysiologyrecordings from scn1Lab mutants exposed to clemizole first in thelocomotion assay (panel FIG. 6D) and then monitored using a forebrainextracellular recording electrode (top trace; ictal-like burst shown ininset). Similar traces are shown for an un-treated Na_(v)1.1 mutant(middle trace) and a mutant treated with zoxazolamine (bottom trace).Analysis of bursting for un-treated mutants (n=3): burstfrequency=1.5±0.3 bursts/min; burst duration=926±414 msec; fractionaltime spent seizing=0.73±0.17% vs. clemizole-treated mutants (n=7): burstfrequency=0.2±0.01 bursts/min; burst duration=154±127 msec; fractionaltime spent seizing=0.03±0.02%; p=0.001 for all comparisons,Kruskal-Wallis ANOVA with a Dunn's pairwise multiple comparison test).Scale bars: large trace 0.5 mV, 10 s; inset 0.5 mV, 100 msec.

FIGS. 7A-7D: Confirmation of clemizole activity in scn1Laa mutants.(FIG. 7A) Representative 10 min recording epochs obtained in theforebrain of paralyzed, immobilized and agar-embedded scn1Laa mutantlarvae at 6 dpf. Note the presence of small and large amplitudespontaneous burst discharge. (FIG. 7B) Locomotion tracking plots for 10individual mutant and wild-type sibling larvae. Plots show swim velocityand locomotion tracks with darker colors indicative of highervelocities; 10 min trials are shown. Seizures were scored on a stagingsystem described in Baraban et al. (Neuroscience 2005). S0, little or noswim activity; S1, increased locomotion; S2 whirlpool like swim activityand S3; full body convulsions with rapid swimming events and loss ofposture. (FIG. 7C) Box plot of mean velocity (in mm/sec) for 96zebrafish with fish sorted into putative scn1Laa and sibling controlpools based on seizure stages described above. The experiments wereperformed by first placing the mutant larvae in embryo media andobtaining a baseline locomotion response, embryo media was then replacedwith new embryo media and a second locomotion response was obtained. Thepercent change in velocity from baseline (recording #1) vs. experimental(recording #2) is shown. In the boxplot, the bottom and top of the boxrepresent the 25th percentile and the 75th percentile, respectively. Theline across the box represents the median value, and the vertical linesencompass the entire range of values. Plots are shown for all 96 fish(left), putative scn1Laa zebrafish (middle) and sibling controls (left).Subsequent PCR analysis was done to confirm mutant and control pools.(FIG. 7D) Plot of the effect of stiripentol (Stp), diazepam (Dzp),clemizole (Clem) and lamotrigine (Ltg) on locomotor seizure behavior inscn1Laa mutants at 5 dpf. Mean velocity is shown before and afterapplication of a drug. N=7 fish per drug. Bars represent mean±S.E.M.Student's paired t-test or Mann-Whitney Rank Sum test with significanceset at p=0.01 (*) or p<0.001 (**).

FIG. 8: Antihistamines do not have antiepileptic properties in scn1Labmutants. Plot of the effect of a variety of antihistamines in thelocomotor seizure assay using scn1Lab mutants at 5 dpf. Mean velocity isshown before and after application of a drug. N=7 fish per drug.Additional compounds are listed at right. Bars represent mean±S.E.M.Student's paired t-test or Mann-Whitney Rank Sum test with significanceset at p=0.01 (*) or p<0.001 (**). Note: some antihistamines increasedseizure activity in this assay.

FIGS. 9A-9B: Clemizole concentration-response studies in scn1Lab. Plotsfrom two different concentration-response studies showing the percentinhibition of mean velocity from a baseline value. N=7 fish perconcentration and trials were performed on separate clutches of mutantlarvae. FIG. 9A: Trial 1; FIG. 9B: Trial 2.

DETAILED DESCRIPTION OF THE INVENTION

“Analog” or “analogue” is used in accordance with its plain ordinarymeaning within Chemistry and Biology and refers to a chemical compoundthat is structurally similar to another compound (i.e., a so-called“reference” compound) but differs in composition, e.g., in thereplacement of one atom by an atom of a different element, or in thepresence of a particular functional group, or the replacement of onefunctional group by another functional group, or the absolutestereochemistry of one or more chiral centers of the reference compound.Accordingly, an analog is a compound that is similar or comparable infunction and appearance but not in structure or origin to a referencecompound.

“Clemizole” refers to a compound having formula:

Clemizole includes pharmaceutically acceptable salts and formulations ofclemizole as described herein (e.g. a “clemizole salt”). Exemplary,clemizole salts include but are not limited to clemizole-HCl,clemizolpenicillin, clemizole-sulfate, or clemizole-undecylate.

A “clemizole analog” as set forth herein refers to compounds of similarstructure. Such compounds include, for example, those compounds setforth in PCT/US2008/076804, and U.S. Pat. No. 4,011,322, which areherein incorporated by reference in their entirety. Further exemplaryclemizole analogs are set forth, for example in: US 2012/0232062; PCTPub. Nos. 2009/038248; US 2010/107739; US 2010/107742, WO 2002/089731.WO 2005/032329, WO 2009/039248, WO 2010/039195, WO 2010/107739, and WO2010/107742, each of which is incorporated herein by reference in theirentirety. Clemizole analogs described herein (including the compoundsdescribed in the references above) may be substituted (i.e. modified) atthe 1 or 2 position as set forth below in formula (I) (boxes Y and Z).Clemizole analogs may be substituted (i.e. modified) at 4, 5, 6, or 7positions as indicated by box X in formula (I).

The term “pharmaceutically acceptable salts” is meant to include saltsof the active compounds that are prepared with relatively nontoxic acidsor bases, depending on the particular substituents found on thecompounds described herein. When clemizole or a clemizole analogcontains relatively acidic functionalities, base addition salts can beobtained by contacting the neutral form of such compounds with asufficient amount of the desired base, either neat or in a suitableinert solvent. Examples of pharmaceutically acceptable base additionsalts include sodium, potassium, calcium, ammonium, organic amino, ormagnesium salt, or a similar salt. When clemizole or a clemizole analogcontain relatively basic functionalities, acid addition salts can beobtained by contacting the neutral form of such compounds with asufficient amount of the desired acid, either neat or in a suitableinert solvent. Examples of pharmaceutically acceptable acid additionsalts include those derived from inorganic acids like hydrochloric,hydrobromic, nitric, carbonic, monohydrogencarbonic, phosphoric,monohydrogenphosphoric, dihydrogenphosphoric, sulfuric,monohydrogensulfuric, hydriodic, or phosphorous acids and the like, aswell as the salts derived from relatively nontoxic organic acids likeacetic, propionic, isobutyric, maleic, malonic, benzoic, succinic,suberic, fumaric, lactic, mandelic, phthalic, benzenesulfonic,p-tolylsulfonic, citric, tartaric, oxalic, methanesulfonic, and thelike. Also included are salts of amino acids such as arginate and thelike, and salts of organic acids like glucuronic or galactunoric acidsand the like (see, for example, Berge et al., “Pharmaceutical Salts”,Journal of Pharmaceutical Science, 1977, 66, 1-19). Clemizole or aclemizole analog may contain both basic and acidic functionalities thatallow conversion into either base or acid addition salts.

Thus, clemizole or a clemizole analog may exist as salts, such as withpharmaceutically acceptable acids. The present invention includes suchsalts. Non-limiting examples of such salts include hydrochlorides,hydrobromides, phosphates, sulfates, methanesulfonates, nitrates,maleates, acetates, citrates, fumarates, propionates, tartrates (e.g.,(+)-tartrates, (−)-tartrates, or mixtures thereof including racemicmixtures), succinates, benzoates, and salts with amino acids such asglutamic acid, and quaternary ammonium salts (e.g. methyl iodide, ethyliodide, and the like). These salts may be prepared by methods known tothose skilled in the art.

The neutral forms of clemizole or a clemizole analog are preferablyregenerated by contacting the salt with a base or acid and isolating theparent compound in the conventional manner. The parent form of thecompound may differ from the various salt forms in certain physicalproperties, such as solubility in polar solvents.

In addition to salt forms, clemizole or a clemizole analog may beprovided in a prodrug form. Prodrugs of clemizole or a clemizole analogare those compounds that readily undergo chemical changes underphysiological conditions to provide the compounds of the presentinvention. Prodrugs of clemizole or a clemizole analog may be convertedin vivo after administration. Additionally, prodrugs of clemizole or aclemizole analog can be converted to active compounds by chemical orbiochemical methods in an ex vivo environment, such as, for example,when contacted with a suitable enzyme or chemical reagent.

Clemizole or a clemizole analog can exist in unsolvated forms as well assolvated forms, including hydrated forms. In general, the solvated formsare equivalent to unsolvated forms and are encompassed within the scopeof the present invention. Clemizole or a clemizole analog may exist inmultiple crystalline or amorphous forms. In general, all physical formsare equivalent for the uses contemplated by the present invention andare intended to be within the scope of the present invention.

An “effective amount” is an amount sufficient for clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)to accomplish a stated purpose relative to the absence of clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)(e.g. achieve the effect for which it is administered, treat a disease,reduce protein/enzyme activity, increase protein/enzyme activity, reducea signaling pathway, or reduce one or more symptoms of a disease orcondition). An example of an “effective amount” is an amount ofclemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) sufficient to contribute to the treatment, prevention, orreduction of a symptom or symptoms of a disease, which could also bereferred to as a “therapeutically effective amount.” A “reduction” of asymptom or symptoms (and grammatical equivalents of this phrase) meansdecreasing of the severity or frequency of the symptom(s), orelimination of the symptom(s) (e.g. seizures). A “prophylacticallyeffective amount” of a drug is an amount of a drug that, whenadministered to a subject, will have the intended prophylactic effect,e.g., preventing or delaying the onset (or reoccurrence) of an injury,disease, pathology or condition, or reducing the likelihood of the onset(or reoccurrence) of an injury, disease, pathology, or condition, ortheir symptoms (e.g. seizures). The full prophylactic effect does notnecessarily occur by administration of one dose, and may occur onlyafter administration of a series of doses. Thus, a prophylacticallyeffective amount may be administered in one or more administrations. Theexact amounts will depend on the purpose of the treatment, and will beascertainable by one skilled in the art using known techniques (see,e.g., Lieberman, Pharmaceutical Dosage Forms (vols. 1-3, 1992); Lloyd,The Art, Science and Technology of Pharmaceutical Compounding (1999);Pickar, Dosage Calculations (1999); and Remington: The Science andPractice of Pharmacy, 20th Edition, 2003, Gennaro, Ed., Lippincott,Williams & Wilkins).

The therapeutically effective amount of clemizole or a clemizole analog(including pharmaceutically acceptable salts thereof) can be initiallydetermined from cell culture assays. Target concentrations will be thoseconcentrations of active compound(s) that are capable of achieving themethods described herein, as measured using the methods described hereinor known in the art.

As is well known in the art, therapeutically effective amounts for usein humans can also be determined from animal models. For example, a dosefor humans can be formulated to achieve a concentration that has beenfound to be effective in animals. The dosage in humans can be adjustedby monitoring compounds effectiveness and adjusting the dosage upwardsor downwards, as described above. Adjusting the dose to achieve maximalefficacy in humans based on the methods described above and othermethods is well within the capabilities of the ordinarily skilledartisan.

Dosages may be varied depending upon the requirements of the patient andthe compound being employed. The dose administered to a patient, in thecontext of the present invention should be sufficient to effect abeneficial therapeutic response in the patient over time. The size ofthe dose also will be determined by the existence, nature, and extent ofany adverse side-effects. Determination of the proper dosage for aparticular situation is within the skill of the practitioner. Generally,treatment is initiated with smaller dosages which are less than theoptimum dose of the compound. Thereafter, the dosage is increased bysmall increments until the optimum effect under circumstances isreached.

Dosage amounts and intervals can be adjusted individually to providelevels of the administered compound effective for the particularclinical indication being treated. This will provide a therapeuticregimen that is commensurate with the severity of the individual'sdisease state.

Utilizing the teachings provided herein, an effective prophylactic ortherapeutic treatment regimen can be planned that does not causesubstantial toxicity and yet is effective to treat the clinical symptomsdemonstrated by the particular patient. This planning should involve thecareful choice of active compound by considering factors such ascompound potency, relative bioavailability, patient body weight,presence and severity of adverse side effects, preferred mode ofadministration and the toxicity profile of the selected agent.

“Control” or “control experiment” is used in accordance with its plainordinary meaning and refers to an experiment in which the subjects orreagents of the experiment are treated as in a parallel experimentexcept for omission of a procedure, reagent, or variable of theexperiment. In some instances, the control is used as a standard ofcomparison in evaluating experimental effects. In some embodiments, acontrol is the measurement of the activity of a protein in the absenceof clemizole or a clemizole analog (including pharmaceuticallyacceptable salts thereof).

A “test compound” as used herein refers to an experimental compound usedin a screening process to identify activity, non-activity, or othermodulation of a particularized biological target or pathway. A testcompound may be a clemizole analog described herein, includingpharmaceutically acceptable salts thereof.

The term “modulation”, “modulate”, or “modulator” are used in accordancewith their plain ordinary meaning and refer to the act of changing orvarying one or more properties. “Modulator” refers to a composition thatincreases or decreases the level of a target molecule or the function ofa target molecule or the physical state of the target of the molecule.“Modulation” refers to the process of changing or varying one or moreproperties. For example, as applied to the effects of a modulator on abiological target, to modulate means to change by increasing ordecreasing a property or function of the biological target or the amountof the biological target.

As defined herein, the term “inhibition”, “inhibit”, “inhibiting” andthe like in reference to a protein-inhibitor interaction meansnegatively affecting (e.g. decreasing) the activity or function of theprotein relative to the activity or function of the protein in theabsence of the inhibitor. In some embodiments inhibition refers toreduction of a disease or symptoms of disease. In some embodiments,inhibition refers to a reduction in the activity of a particular proteinor nucleic acid target. Thus, inhibition includes, at least in part,partially or totally blocking stimulation, decreasing, preventing, ordelaying activation, or inactivating, desensitizing, or down-regulatingsignal transduction or protein/enzymatic activity or the amount of aprotein. Inhibition as used herein may refer to inhibition of avoltage-gated sodium channel.

The term “activation” or “activating” and the like refer toprotein-compound interactions that positively affect (e.g. increase) theactivity or function of the protein relative to the activity or functionof the protein in absence of the activator. Activation may refer toenhanced activity of a particular protein target. Activation may referto restoration of loss-of-function of a mutated protein target.Activation as used herein may refer to activation of a voltage-gatedsodium channel.

“Contacting” is used in accordance with its plain ordinary meaning andrefers to the process of allowing at least two distinct species (e.g.chemical compounds including biomolecules or cells) to becomesufficiently proximal to react, interact or physically touch. It shouldbe appreciated; however, the resulting reaction product can be produceddirectly from a reaction between the added reagents or from anintermediate from one or more of the added reagents that can be producedin the reaction mixture.

The term “contacting” may include allowing two species to react,interact, or physically touch, wherein the two species may be a compoundas described herein and a protein or enzyme. In some embodimentscontacting includes allowing a compound described herein to interactwith a protein or enzyme that is involved in a signaling pathway.

The term “associated” or “associated with” in the context of a substanceor substance activity or function associated with a disease means thatthe disease is caused by (in whole or in part), or a symptom of thedisease is caused by (in whole or in part) the substance or substanceactivity or function.

“Patient” or “subject in need thereof” refers to a living organismsuffering from or prone to a disease or condition that can be treated byadministration of a pharmaceutical composition as provided herein.Non-limiting examples include humans, other mammals, bovines, rats,mice, dogs, monkeys, goat, sheep, cows, deer, and other non-mammaliananimals such as zebrafish. A patient may be human.

“Disease” or “condition” refer to a state of being or health status of apatient or subject capable of being treated with the compounds ormethods provided herein.

The terms “epileptic disorder,” “epilepsy disorder,” “seizure disorder,”or “epilepsy” herein refer to a spectrum of chronic neurologicaldisorders most often characterized by the presence of unprovokedseizures. See e.g. Noebels et. al., Jasper's Basic Mechanisms of theEpilepsies, 4th edition, Bethesda (Md.): National Center forBiotechnology Information (US); 2012. Epilepsy as used herein, may referto injury to the brain (e.g. from trauma, stroke, or cancer) or geneticmutation. The symptoms of epilepsy disorders may result from abnormalelectrochemical signaling between neurons in the brain. Patientsexperiencing two or more unprovoked seizures may be considered to haveepilepsy.

Types of epilepsy disorders include, for example, benign Rolandicepilepsy, frontal lobe epilepsy, infantile spasms, juvenile myoclonicepilepsy (JME), juvenile absence epilepsy, childhood absence epilepsy(e.g. pyknolepsy), febrile seizures, progressive myoclonus epilepsy ofLafora, Lennox-Gastaut syndrome, Landau-Kleffner syndrome, Dravetsyndrome (DS), Generalized Epilepsy with Febrile Seizures (GEFS+),Severe Myoclonic Epilepsy of Infancy (SMEI), Benign Neonatal FamilialConvulsions (BFNC), West Syndrome, Ohtahara Syndrome, early myoclonicencephalopathies, migrating partial epilepsy, infantile epilepticencephalopathies, Tuberous Sclerosis Complex (TSC), focal corticaldysplasia, Type I Lissencephaly, Miller-Dieker Syndrome, Angelman'ssyndrome, Fragile X syndrome, epilepsy in autism spectrum disorders,subcortical band heterotopia, Walker-Warburg syndrome, Alzheimer'sdisease, posttraumatic epilepsy, progressive myoclonus epilepsies,reflex epilepsy, Rasmussen's syndrome, temporal lobe epilepsy, limbicepilepsy, status epilepticus, abdominal epilepsy, massive bilateralmyoclonus, catamenial epilepsy, Jacksonian seizure disorder,Unverricht-Lundborg disease, or photosensitive epilepsy.

“Pharmaceutically acceptable excipient” and “pharmaceutically acceptablecarrier” or “carrier moiety” refer to a substance that aids theadministration of clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) to and absorption by asubject and can be included in the compositions without causing asignificant adverse toxicological effect on the patient. Non-limitingexamples of pharmaceutically acceptable excipients include water, NaCl,normal saline solutions, lactated Ringer's, normal sucrose, normalglucose, binders, fillers, disintegrants, lubricants, coatings,sweeteners, flavors, salt solutions (such as Ringer's solution),alcohols, oils, gelatins, carbohydrates such as lactose, amylose orstarch, fatty acid esters, hydroxymethylcellulose, polyvinylpyrrolidine, and colors, and the like. Such preparations can besterilized and, if desired, mixed with auxiliary agents such aslubricants, preservatives, stabilizers, wetting agents, emulsifiers,salts for influencing osmotic pressure, buffers, coloring, and/oraromatic substances and the like that do not deleteriously react withthe compounds of the invention. One of skill in the art will recognizethat other pharmaceutically acceptable excipients are useful in thepresent invention.

The term “preparation” is intended to include the formulation ofclemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) with encapsulating material as a carrier providing acapsule in which the active component with or without other carriers, issurrounded by a carrier, which is thus in association with it.Similarly, cachets and lozenges are included. Tablets, powders,capsules, pills, cachets, and lozenges can be used as solid dosage formssuitable for oral administration.

As used herein, the term “administering” means oral administration,administration as a suppository, topical contact, intravenous,intraperitoneal, intramuscular, intralesional, intrathecal, intranasalor subcutaneous administration, or the implantation of a slow-releasedevice, e.g., a mini-osmotic pump, to a subject. Administration is byany route, including parenteral and transmucosal (e.g., buccal,sublingual, palatal, gingival, nasal, vaginal, rectal, or transdermal).Parenteral administration includes, e.g., intravenous, intramuscular,intra-arteriole, intradermal, subcutaneous, intraperitoneal,intraventricular, and intracranial. Other modes of delivery include, butare not limited to, the use of liposomal formulations, intravenousinfusion, transdermal patches, etc.

Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) and pharmaceutical compositions thereof can be deliveredtransdermally, by a topical route, formulated as applicator sticks,solutions, suspensions, emulsions, gels, creams, ointments, pastes,jellies, paints, powders, and aerosols. Oral preparations includetablets, pills, powder, dragees, capsules, liquids, lozenges, cachets,gels, syrups, slurries, suspensions, etc., suitable for ingestion by thepatient. Solid form preparations include powders, tablets, pills,capsules, cachets, suppositories, and dispersible granules. Liquid formpreparations include solutions, suspensions, and emulsions, for example,water or water/propylene glycol solutions. Clemizole or a clemizoleanalog (including pharmaceutically acceptable salts thereof) mayadditionally include components to provide sustained release and/orcomfort. Such components include high molecular weight, anionicmucomimetic polymers, gelling polysaccharides and finely-divided drugcarrier substrates. These components are discussed in greater detail inU.S. Pat. Nos. 4,911,920; 5,403,841; 5,212,162; and 4,861,760. Theentire contents of these patents are incorporated herein by reference intheir entirety for all purposes. Clemizole or a clemizole analog(including pharmaceutically acceptable salts thereof) can also bedelivered as microspheres for slow release in the body. For example,microspheres can be administered via intradermal injection ofdrug-containing microspheres, which slowly release subcutaneously (seeRao, J. Biomater Sci. Polym. Ed. 7:623-645, 1995; as biodegradable andinjectable gel formulations (see, e.g., Gao Pharm. Res. 12:857-863,1995); or, as microspheres for oral administration (see, e.g., Eyles, J.Pharm. Pharmacol. 49:669-674, 1997). The formulations of thecompositions of clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) can be delivered by the useof liposomes which fuse with the cellular membrane or are endocytosed,i.e., by employing receptor ligands attached to the liposome, that bindto surface membrane protein receptors of the cell resulting inendocytosis. By using liposomes, particularly where the liposome surfacecarries receptor ligands specific for target cells, or are otherwisepreferentially directed to a specific organ, one can focus the deliveryof the compositions of clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) into the target cells invivo. (See, e.g., Al-Muhammed, J. Microencapsul. 13:293-306, 1996;Chonn, Curr. Opin. Biotechnol. 6:698-708, 1995; Ostro, Am. J. Hosp.Pharm. 46:1576-1587, 1989). The compositions can also be delivered asnanoparticles.

By “co-administer” it is meant that a composition described herein isadministered at the same time, just prior to, or just after theadministration of one or more additional therapies. Clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)can be administered alone or can be co-administered to the patient.Co-administration is meant to include simultaneous or sequentialadministration of the compounds individually or in combination (morethan one compound). Thus, the preparations can also be combined, whendesired, with other active substances (e.g. to reduce metabolicdegradation). Clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) can be deliveredtransdermally, by a topical route, or formulated as applicator sticks,solutions, suspensions, emulsions, gels, creams, ointments, pastes,jellies, paints, powders, and aerosols.

The terms “add on therapy,” “add-on therapy,” “adjunct therapy,” and“adjunctive therapy” are used interchangeably herein and refer tocombining clemizole, a clemizole analog, or a pharmaceuticallyacceptable salt thereof with another anticonvulsant to treat epilepsy.

An “anti-seizure drug”, “anti-epilepsy drug”, “AED” or “anticonvulsant”are used interchangeably herein and according to their common andordinary meaning and include compositions for reducing or eliminatingseizures. Anticonvulsants include, but are not limited to acetazolamide,benzodiazepine, cannabadiols, carbamazepine, clobazam, clonazepam,eslicarbazepine acetate, ethosuximide, ethotoin, felbamate,fenfluramine, fosphenytoin, gabapentin, ganaxolone, huperzine A,lacosamide, lamotrigine, levetiracetam, nitrazepam, oxcarbazepine,perampanel, piracetam, phenobarbital, phenytoin, potassium bromide,pregabalin, primidone, retigabine, rufinamide, sodium valproate,stiripentol, tiagabine, topiramate, vigabatrin, or zonisamide.

I. METHODS OF TREATMENT

Provided herein are methods of treating an epilepsy disorder. In oneaspect, the method is a method of treating an epilepsy disorder byadministering to a subject in need thereof, a therapeutically effectiveamount of clemizole, a clemizole analog, or a pharmaceuticallyacceptable salt thereof. In another aspect, the method is a method oftreating an epilepsy disorder by administering to a subject in needthereof, a pharmaceutical composition as described herein, where thepharmaceutical composition includes clemizole, a clemizole analog, or apharmaceutically acceptable salt thereof. The analog of clemizole mayinclude compounds of similar structure as set forth, in for example,PCT/US2008/076804, WO10107739, WO2009039248, or U.S. Pat. No. 4,011,322,which are incorporated herein by reference. The pharmaceuticallyacceptable salt may be clemizole HCl. The subject may have (e.g. may eatfood in accordance with) a ketogenic diet. The subject may be a child(e.g. a subject having a pediatric epilepsy condition).

The epilepsy disorder may be benign Rolandic epilepsy, frontal lobeepilepsy, infantile spasms, juvenile myoclonic epilepsy (JME), juvenileabsence epilepsy, childhood absence epilepsy (e.g. pyknolepsy), febrileseizures, progressive myoclonus epilepsy of Lafora, Lennox-Gastautsyndrome, Landau-Kleffner syndrome, Dravet syndrome, GeneralizedEpilepsy with Febrile Seizures (GEFS+), Severe Myoclonic Epilepsy ofInfancy (SMEI), Benign Neonatal Familial Convulsions (BFNC), WestSyndrome, Ohtahara Syndrome, early myoclonic encephalopathies, migratingpartial epilepsy, infantile epileptic encephalopathies, TuberousSclerosis Complex (TSC), focal cortical dysplasia, Type I Lissencephaly,Miller-Dieker Syndrome, Angelman's syndrome, Fragile X syndrome,epilepsy in autism spectrum disorders, subcortical band heterotopia,Walker-Warburg syndrome, Alzheimer's disease, posttraumatic epilepsy,progressive myoclonus epilepsies, reflex epilepsy, Rasmussen's syndrome,temporal lobe epilepsy, limbic epilepsy, status epilepticus, abdominalepilepsy, massive bilateral myoclonus, catamenial epilepsy, Jacksonianseizure disorder, Unverricht-Lundborg disease, or photosensitiveepilepsy. The epilepsy may include generalized seizures or partial (i.e.focal) seizures.

The epilepsy disorder may be Dravet Syndrome, Lennox-Gastaut Syndrome,infantile spasm, or Ohtahara Syndrome. The epilepsy disorder may beDravet Syndrome, Lennox-Gastaut Syndrome, infantile spasm, or OhtaharaSyndrome, or a pediatric epilepsy disorder. The pediatric epilepsydisorder may be benign childhood epilepsy, Benign Neonatal FamilialConvulsions (BFNC), febrile seizures, Dravet Syndrome, Lennox-GastautSyndrome, infantile spasm, Ohtahara Syndrome, juvenile myoclonicepilepsy, juvenile absence epilepsy, childhood absence epilepsy (e.g.pyknolepsy), infantile spasms. The epilepsy disorder may be DravetSyndrome.

The pediatric epilepsy disorder may be benign childhood epilepsy. Thepediatric epilepsy disorder may be Benign Neonatal Familial Convulsions(BFNC). The pediatric epilepsy disorder may be febrile seizures. Thepediatric epilepsy disorder may be Dravet Syndrome. The pediatricepilepsy disorder may be Lennox-Gastaut Syndrome. The pediatric epilepsydisorder may be infantile spasm. The pediatric epilepsy disorder may beOhtahara Syndrome. The pediatric epilepsy disorder may be juvenilemyoclonic epilepsy. The pediatric epilepsy disorder may be juvenileabsence epilepsy. The pediatric epilepsy disorder may be childhoodabsence epilepsy (e.g. pyknolepsy). The pediatric epilepsy disorder maybe infantile spasms.

The epilepsy disorder may be a result of a neurological disease orinjury such as, for example, encephalitis, cerebritis, abscess, stroke,tumor, trauma, genetic, tuberous sclerosis, cerebral dysgenesis, orhypoxic-ischemic encephalopathy. The epilepsy disorder may be associatedwith a neurodegenerative disease such as, for example, Alzheimer'sdisease or Parkinson's Disease. The epilepsy disorder may be associatedwith autism. The epilepsy disorder may be associated with a single genemutation. The epilepsy disease may be associated with compulsivebehaviors or electrographic seizures. The administration of clemizole, aclemizole analog, or a pharmaceutical acceptable salt thereof mayinhibit compulsive behaviors or electrographic seizures in a epilepsydisorder, in an Alzheimer's disease subject (e.g. a subject sufferingfrom Alzheimer's disease), in an autism subject (e.g. a subject havingautism), or in a Parkinson's disease subject (e.g. a subject sufferingfrom Parkinson's disease). Thus, clemizole, a clemizole analog, or apharmaceutical acceptable salt thereof may inhibit compulsive behaviorsor electrographic seizures in a epilepsy disorder. Clemizole, aclemizole analog, or a pharmaceutical acceptable salt thereof mayinhibit compulsive behaviors or electrographic seizures in anAlzheimer's disease subject. Clemizole, a clemizole analog, or apharmaceutical acceptable salt thereof may inhibit compulsive behaviorsor electrographic seizures in an autism subject. Clemizole, a clemizoleanalog, or a pharmaceutical acceptable salt thereof may inhibitcompulsive behaviors or electrographic seizures in a Parkinson's diseasesubject.

The administration of clemizole, a clemizole analog, or a pharmaceuticalacceptable salt thereof may reduce the incidence (e.g. number ofoccurrences) of unprovoked seizures in the subject compared to theabsence of clemizole, the clemizole analog, or the pharmaceuticallyacceptable salt thereof. Thus, a patient's response to theadministration of clemizole, a clemizole analog, or a pharmaceuticalacceptable salt thereof, may be monitored progressively compared to atime before the administration of compounds described herein (e.g. acontrol or control time).

The administration of clemizole, a clemizole analog, or a pharmaceuticalacceptable salt thereof may reduce or prevent myoclonus seizures orstatus epilepticus in the subject compared to the absence of clemizole,the clemizole analog, or the pharmaceutically acceptable salt thereof.The administration of clemizole, a clemizole analog, or a pharmaceuticalacceptable salt thereof may reduce or prevent myoclonus seizures in thesubject compared to the absence of clemizole, the clemizole analog, orthe pharmaceutically acceptable salt thereof. The administration ofclemizole, a clemizole analog, or a pharmaceutical acceptable saltthereof may reduce or prevent status epilepticus in the subject comparedto the absence of clemizole, the clemizole analog, or thepharmaceutically acceptable salt thereof. Thus, a patient's response tothe administration of clemizole, a clemizole analog, or a pharmaceuticalacceptable salt thereof, may be monitored progressively compared to atime before the administration of compounds described herein (e.g. acontrol or control time).

The epilepsy disorder may be an epilepsy disorder which isnon-responsive to treatment with an antiepileptic drug (AED). Thesubject may eat a ketogenic diet. The epilepsy disorder may be anepilepsy disorder in an adult (e.g. more than about 16 years old).

The epilepsy disorder may be an epilepsy disorder in children. Thus, theepilepsy disorder may be a pediatric epilepsy disorder. The child may beless than about 1 week old. The child may be less than about 1 monthold. The child may be less than about 6 months old. The child may beless than about 12 months old. The child may be less than about 2 yearsold. The child may be less than about 3 years old. The child may be lessthan about 4 years old. The child may be less than about 5 years old.The child may be less than about 6 years old. The child may be less thanabout 7 years old. The child may be less than about 8 years old. Thechild may be less than about 9 years old. The child may be less thanabout 10 years old. The child may be less than about 12 years old.

The child may be more than about 1 week old. The child may be more thanabout 1 month old. The child may be more than about 6 months old. Thechild may be more than about 12 months old. The child may be more thanabout 2 years old. The child may be more than about 3 years old. Thechild may be more than about 4 years old. The child may be more thanabout 5 years old. The child may be more than about 5 years old. Thechild may be more than about 6 years old. The child may be more thanabout 7 years old. The child may be more than about 8 years old. Thechild may be more than about 9 years old. The child may be more thanabout 10 years old. The child may be more than about 11 years old. Thechild may be more than about 12 years old.

The child may have an epilepsy disorder treated by administering an AEDas described herein. Thus, clemizole, a clemizole analog, or apharmaceutically acceptable salt thereof may be administered to such achild (e.g. as an add-on therapy).

In another aspect, is a method of treating Dravet Syndrome. The methodof treating Dravet Syndrome includes administering to a subject in needthereof, a therapeutically effective amount of clemizole, a clemizoleanalog, or a pharmaceutically acceptable salt thereof. The method oftreating Dravet Syndrome may include administering to a subject in needthereof, a pharmaceutical composition of clemizole, a clemizole analogor a pharmaceutically acceptable salt thereof as described herein. Theanalog of clemizole may include compounds of formula (I) describedherein and may include compounds of similar structure as set forth, infor example, PCT/US2008/076804, WO10107739, WO2009039248, or U.S. Pat.No. 4,011,322, which are incorporated herein by reference. Clemizole, ora clemizole analog (including pharmaceutically acceptable salts thereof)may be co-administered to a subject in need thereof with an AED asdescribed herein.

In the methods described herein, clemizole or a clemizole analog(including pharmaceutically acceptable salts thereof) may beco-administered with an anti-epileptic drug (AED). The AED may beacetazolamide, benzodiazepine, cannabadiols, carbamazepine, clobazam,clonazepam, eslicarbazepine acetate, ethosuximide, ethotoin, felbamate,fenfluramine, fosphenytoin, gabapentin, ganaxolone, huperzine A,lacosamide, lamotrigine, levetiracetam, nitrazepam, oxcarbazepine,perampanel, piracetam, phenobarbital, phenytoin, potassium bromide,pregabalin, primidone, retigabine, rufinamide, sodium valproate,stiripentol, tiagabine, topiramate, vigabatrin, or zonisamide. The AEDmay be valproic acid, valproate, clonazepam, ethosuximide, felbamate,gabapentin, carbamazepine, oxcarbazepine, lamotrigine, levetiracetam,benzodiazepine, phenobarbital, pregabalin, primidone, tiagabine,topiramate, potassium bromide, phenytoin, stiripentol, vigabatrin, orzonisamide. The AED may be valproic acid, valproate, Gabapentin,topiramate, carbamazepine, oxcarbazepine, or vigabatrin.

The AED may be acetazolamide. The AED may be benzodiazepine. The AED maybe cannabadiols. The AED may be carbamazepine. The AED may be clobazam.The AED may be clonazepam. The AED may be eslicarbazepine acetate. TheAED may be ethosuximide. The AED may be ethotoin. The AED may befelbamate. The AED may be fenfluramine. The AED may be fosphenytoin. TheAED may be gabapentin. The AED may be ganaxolone. The AED may behuperzine A. The AED may be lacosamide. The AED may be lamotrigine. TheAED may be levetiracetam. The AED may be nitrazepam. The AED may beoxcarbazepine. The AED may be perampanel. The AED may be piracetam. TheAED may be phenobarbital. The AED may be phenytoin. The AED may bepotassium bromide. The AED may be pregabalin. The AED may be primidone.The AED may be retigabine. The AED may be rufinamide. The AED may besodium valproate. The AED may be stiripentol. The AED may be tiagabine.The AED may be topiramate. The AED may be vigabatrin. The AED may bezonisamide. Clemizole or a clemizole analog (including pharmaceuticallyacceptable salts thereof) or a pharmaceutical composition of clemizoleor a clemizole analog may be administered as an adjunctive therapy toone or more of the AEDs described herein.

Clemizole, a clemizole analog, or a pharmaceutically acceptable saltthereof may thus be administered as an add-on (e.g. in combination with)AED medications for treating seizures, including seizures associatedwith the epilepsy disorders described herein. Clemizole, a clemizoleanalog, or a pharmaceutically acceptable salt thereof may beadministered as an adjunctive therapy (e.g. in combination with) AEDmedications for treating seizures, including seizures associated withthe epilepsy disorders described herein.

The epilepsy disorder may be characterized by partial seizures orgeneralized seizures. The epilepsy disorder may be characterized bypartial seizures. The epilepsy disorder may be characterized bygeneralized seizures. The partial seizure may be a simple focal seizure,a complex focal seizure, or a partial focal seizure with secondarygeneralization. The generalized seizure may be a generalizedtonic-clonic seizure, an absence seizure (i.e. petit mal), a myoclonicseizure, a clonic seizure, a tonic seizure, or a atonic seizure.

When co-administered with the AEDs described herein, clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)may be administered simultaneously. When administered simultaneously,clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be formulated together with the AED (i.e. in a singledosage unit). Clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) may be formulated forseparate administration from the AED but administered at the same time.When co-administered with AEDs described herein, clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)may be administered sequentially (e.g. before or after) theadministration of the AED. As set forth herein, one skilled in the artcould readily determine the sequential order of administration.

Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 1 mg/kg to about1000 mg/kg. Clemizole or a clemizole analog (including pharmaceuticallyacceptable salts thereof) may be administered at a dose of about 10mg/kg to about 1000 mg/kg. Clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) may be administered at a doseof about 25 mg/kg to about 500 mg/kg. Clemizole or a clemizole analog(including pharmaceutically acceptable salts thereof) may beadministered at a dose of about 25 mg/kg to about 400 mg/kg. Clemizoleor a clemizole analog (including pharmaceutically acceptable saltsthereof) may be administered at a dose of about 25 mg/kg to about 350mg/kg. Clemizole or a clemizole analog (including pharmaceuticallyacceptable salts thereof) may be administered at a dose of about 25mg/kg to about 300 mg/kg. Clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) may be administered at a doseof about 25 mg/kg to about 250 mg/kg. Clemizole or a clemizole analog(including pharmaceutically acceptable salts thereof) may beadministered at a dose of about 25 mg/kg to about 200 mg/kg. Clemizoleor a clemizole analog (including pharmaceutically acceptable saltsthereof) may be administered at a dose of about 25 mg/kg to about 150mg/kg. Clemizole or a clemizole analog (including pharmaceuticallyacceptable salts thereof) may be administered at a dose of about 25mg/kg to about 100 mg/kg. Clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) may be administered at a doseof about 25 mg/kg to about 75 mg/kg. Clemizole or a clemizole analog(including pharmaceutically acceptable salts thereof) may beadministered at a dose of about 25 mg/kg to about 50 mg/kg. As usedherein “mg/kg” refers to mg per kg body weight of the subject. Dosagesdescribed herein include administration of clemizole or a clemizoleanalog (including pharmaceutically acceptable salts thereof) as a singletherapeutic active agent or administration of clemizole or a clemizoleanalog (including pharmaceutically acceptable salts thereof) as atherapeutic active agent in combination (as described herein) with anAED described herein.

Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 1 mg/kg. Clemizoleor a clemizole analog (including pharmaceutically acceptable saltsthereof) may be administered at a dose of about 5 mg/kg. Clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)may be administered at a dose of about 10 mg/kg. Clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)may be administered at a dose of about 20 mg/kg. Clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)may be administered at a dose of about 25 mg/kg. Clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)may be administered at a dose of about 30 mg/kg. Clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)may be administered at a dose of about 40 mg/kg. Clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)may be administered at a dose of about 50 mg/kg. Clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)may be administered at a dose of about 75 mg/kg. Clemizole or aclemizole analog (including pharmaceutically acceptable salts thereof)may be administered at a dose of about 100 mg/kg.

Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 125 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 150 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 175 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 200 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 225 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 250 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 275 mg/kg.

Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 300 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 325 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 350 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 375 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 400 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 425 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 450 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 475 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 500 mg/kg.

Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 600 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 700 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 800 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 900 mg/kg.Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered at a dose of about 1000 mg/kg.

Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered in the dosages described herein atleast once a day (e.g. once every 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or12 hours). Clemizole or a clemizole analog (including pharmaceuticallyacceptable salts thereof) may be administered daily in the dosagesdescribed herein. Clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) may be administered at leasttwice a week in the dosages described herein. Clemizole or a clemizoleanalog (including pharmaceutically acceptable salts thereof) may beadministered at least three times a week as described herein. Clemizoleor a clemizole analog (including pharmaceutically acceptable saltsthereof) may be administered monthly as described herein.

II. PHARMACEUTICAL COMPOSITIONS

Provided herein are pharmaceutical compositions for treating an epilepsydisease described herein. In one aspect, is a pharmaceutical compositionthat includes clemizole, a clemizole analog, or a pharmaceuticallyacceptable salt thereof. The pharmaceutical composition may also includea pharmaceutically acceptable excipient. The pharmaceutically acceptablesalt of clemizole in the pharmaceutical composition may be clemizoleHCl. The pharmaceutical composition may be formulated as a tablet, apowder, a capsule, a pill, a cachet, or a lozenge as described herein.The pharmaceutical composition may be formulated as a tablet, capsule,pill, cachet, or lozenge for oral administration. The pharmaceuticalcomposition may be formulated for dissolution into a solution foradministration by such techniques as, for example, intravenousadministration. The pharmaceutical composition may be formulated fororal administration, suppository administration, topical administration,intravenous administration, intraperitoneal administration,intramuscular administration, intralesional administration, intrathecaladministration, intranasal administration, subcutaneous administration,implantation, transdermal administration, or transmucosal administrationas described herein.

When administered as pharmaceutical composition, the pharmaceuticalcompositions may include optical isomers, diastereomers, enantiomers,isoforms, polymorphs, hydrates, solvates or products, orpharmaceutically acceptable salts of clemizole or a clemizole analogdescribed herein (e.g. agents, modulators, inhibitors, antagonists).Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) included in the pharmaceutical composition may becovalently attached to a carrier moiety, as described above.Alternatively, clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) included in thepharmaceutical composition is not covalently linked to a carrier moiety.

Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) may be administered alone or co-administered to a subjectin need thereof with an AED as described herein. Pharmaceuticalcompositions of clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof). Co-administration is meantto include simultaneous or sequential administration as described hereinof clemizole or a clemizole analog individually or in combination (e.g.more than one compound—e.g. an AED described herein). The preparationscan also be combined, when desired, with other active substances (e.g.to prevent seizures).

1. Formulations

Clemizole, a clemizole analog (including pharmaceutically acceptablesalts thereof) or a pharmaceutical composition described herein can beprepared and administered in a wide variety of oral, parenteral, andtopical dosage forms. Thus, clemizole, a clemizole analog (includingpharmaceutically acceptable salts thereof) or a pharmaceuticalcomposition described herein can be administered by injection (e.g.intravenously, intramuscularly, intracutaneously, subcutaneously,intraduodenally, or intraperitoneally). Also, clemizole, a clemizoleanalog (including pharmaceutically acceptable salts thereof) or apharmaceutical composition described herein can be administered byinhalation, for example, intranasally. Additionally, clemizole, aclemizole analog (including pharmaceutically acceptable salts thereof)or a pharmaceutical composition can be administered transdermally. It isalso envisioned that multiple routes of administration (e.g.,intramuscular, oral, transdermal) can be used to administer clemizole, aclemizole analog (including pharmaceutically acceptable salts thereof)or a pharmaceutical composition. The pharmaceutical compositionsdescribed herein may include a pharmaceutically acceptable carrier orexcipient and one or more of clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof). The pharmaceuticalcompositions described herein may include a pharmaceutically acceptablecarrier or excipient, one or more of clemizole or a clemizole analog(including pharmaceutically acceptable salts thereof) and an one or moreAED as described herein.

Preparation may include pharmaceutically acceptable carriers. Thepharmaceutically acceptable carriers can be either solid or liquid.Solid form preparations include powders, tablets, pills, capsules,cachets, suppositories, and dispersible granules. A solid carrier may beone or more substance that may also act as diluents, flavoring agents,binders, preservatives, tablet disintegrating agents, or anencapsulating material.

In powders, the carrier may be a finely divided solid in a mixture withthe finely divided active component. In tablets, the active componentmay be mixed with the carrier having the necessary binding properties insuitable proportions and compacted in the shape and size desired.

The powders and tablets preferably contain from 5% to 70% of the activecompound. Suitable carriers are magnesium carbonate, magnesium stearate,talc, sugar, lactose, pectin, dextrin, starch, gelatin, tragacanth,methylcellulose, sodium carboxymethylcellulose, a low melting wax, cocoabutter, and the like. The term “preparation” is intended to include theformulation of the active compound with encapsulating material as acarrier providing a capsule in which the active component with orwithout other carriers, is surrounded by a carrier, which is thus inassociation with it. Similarly, cachets and lozenges are included.Tablets, powders, capsules, pills, cachets, and lozenges can be used assolid dosage forms suitable for oral administration.

Suitable solid excipients include, but are not limited to, magnesiumcarbonate; magnesium stearate; talc; pectin; dextrin; starch;tragacanth; a low melting wax; cocoa butter; carbohydrates; sugarsincluding, but not limited to, lactose, sucrose, mannitol, or sorbitol,starch from corn, wheat, rice, potato, or other plants; cellulose suchas methyl cellulose, hydroxypropylmethyl-cellulose, or sodiumcarboxymethylcellulose; and gums including arabic and tragacanth; aswell as proteins including, but not limited to, gelatin and collagen. Ifdesired, disintegrating or solubilizing agents may be added, such as thecross-linked polyvinyl pyrrolidone, agar, alginic acid, or a saltthereof, such as sodium alginate.

Dragee cores are provided with suitable coatings such as concentratedsugar solutions, which may also contain gum arabic, talc,polyvinylpyrrolidone, carbopol gel, polyethylene glycol, and/or titaniumdioxide, lacquer solutions, and suitable organic solvents or solventmixtures. Dyestuffs or pigments may be added to the tablets or drageecoatings for product identification or to characterize the quantity ofclemizole, a clemizole analog (including pharmaceutically acceptablesalts thereof) or a pharmaceutical composition (i.e., dosage).Pharmaceutical preparations described herein can also be used orallyusing, for example, push-fit capsules made of gelatin, as well as soft,sealed capsules made of gelatin and a coating such as glycerol orsorbitol.

For preparing suppositories, a low melting wax, such as a mixture offatty acid glycerides or cocoa butter, is first melted and the activecomponent is dispersed homogeneously therein, as by stirring. The moltenhomogeneous mixture is then poured into convenient sized molds, allowedto cool, and thereby to solidify.

Liquid form preparations include solutions, suspensions, and emulsions,for example, water or water/propylene glycol solutions. For parenteralinjection, liquid preparations can be formulated in solution in aqueouspolyethylene glycol solution.

When parenteral application is needed or desired, particularly suitableadmixtures for clemizole, a clemizole analog (including pharmaceuticallyacceptable salts thereof) or a pharmaceutical composition areinjectable, sterile solutions, preferably oily or aqueous solutions, aswell as suspensions, emulsions, or implants, including suppositories. Inparticular, carriers for parenteral administration include aqueoussolutions of dextrose, saline, pure water, ethanol, glycerol, propyleneglycol, peanut oil, sesame oil, polyoxyethylene-block polymers, and thelike. Ampoules are convenient unit dosages. Clemizole, a clemizoleanalog (including pharmaceutically acceptable salts thereof) or apharmaceutical composition can also be incorporated into liposomes oradministered via transdermal pumps or patches. Pharmaceutical admixturessuitable for use herein include those described, for example, inPharmaceutical Sciences (17th Ed., Mack Pub. Co., Easton, Pa.) and WO96/05309, the teachings of both of which are hereby incorporated byreference.

Aqueous solutions suitable for oral use can be prepared by dissolvingthe active component in water and adding suitable colorants, flavors,stabilizers, and thickening agents as desired. Aqueous suspensionssuitable for oral use can be made by dispersing the finely dividedactive component in water with viscous material, such as natural orsynthetic gums, resins, methylcellulose, sodium carboxymethylcellulose,hydroxypropylmethylcellulose, sodium alginate, polyvinylpyrrolidone, gumtragacanth and gum acacia, and dispersing or wetting agents such as anaturally occurring phosphatide (e.g., lecithin), a condensation productof an alkylene oxide with a fatty acid (e.g., polyoxyethylene stearate),a condensation product of ethylene oxide with a long chain aliphaticalcohol (e.g., heptadecaethylene oxycetanol), a condensation product ofethylene oxide with a partial ester derived from a fatty acid and ahexitol (e.g., polyoxyethylene sorbitol mono-oleate), or a condensationproduct of ethylene oxide with a partial ester derived from fatty acidand a hexitol anhydride (e.g., polyoxyethylene sorbitan mono-oleate).The aqueous suspension can also contain one or more preservatives suchas ethyl or n-propyl p-hydroxybenzoate, one or more coloring agents, oneor more flavoring agents and one or more sweetening agents, such assucrose, aspartame or saccharin. Formulations can be adjusted forosmolarity.

Also included herein are solid form preparations that are intended to beconverted, shortly before use, to liquid form preparations for oraladministration. Such liquid forms include solutions, suspensions, andemulsions. These preparations may contain, in addition to the activecomponent, colorants, flavors, stabilizers, buffers, artificial andnatural sweeteners, dispersants, thickeners, solubilizing agents, andthe like.

Oil suspensions can contain a thickening agent, such as beeswax, hardparaffin or cetyl alcohol. Sweetening agents can be added to provide apalatable oral preparation, such as glycerol, sorbitol or sucrose. Theseformulations can be preserved by the addition of an antioxidant such asascorbic acid. As an example of an injectable oil vehicle, see Minto, J.Pharmacol. Exp. Ther. 281:93-102, 1997. The pharmaceutical formulationsdescribed herein can also be in the form of oil-in-water emulsions. Theoily phase can be a vegetable oil or a mineral oil, described above, ora mixture of these. Suitable emulsifying agents includenaturally-occurring gums, such as gum acacia and gum tragacanth,naturally occurring phosphatides, such as soybean lecithin, esters orpartial esters derived from fatty acids and hexitol anhydrides, such assorbitan mono-oleate, and condensation products of these partial esterswith ethylene oxide, such as polyoxyethylene sorbitan mono-oleate. Theemulsion can also contain sweetening agents and flavoring agents, as inthe formulation of syrups and elixirs. Such formulations can alsocontain a demulcent, a preservative, or a coloring agent.

The pharmaceutical preparation is preferably in unit dosage form. Insuch form the preparation is subdivided into unit doses containingappropriate quantities of the active component. The unit dosage form canbe a packaged preparation, the package containing discrete quantities ofpreparation, such as packeted tablets, capsules, and powders in vials orampoules. Also, the unit dosage form can be a capsule, tablet, cachet,or lozenge itself, or it can be the appropriate number of any of thesein packaged form.

The quantity of active component in a unit dose preparation may bevaried or adjusted from 0.1 mg to 10000 mg according to the particularapplication and the potency of the active component. The compositioncan, if desired, also contain other compatible therapeutic agents.

Formulations may include a surfactant or other appropriate co-solvent inthe composition. Such co-solvents include: Polysorbate 20, 60, and 80;PLURONIC® F-68, F-84, and P-103; cyclodextrin; and polyoxyl 35 castoroil. Such co-solvents are typically employed at a level between about0.01% and about 2% by weight. Viscosity greater than that of simpleaqueous solutions may be desirable to decrease variability in dispensingthe formulations, to decrease physical separation of components of asuspension or emulsion of formulation, and/or otherwise to improve theformulation. Such viscosity-building agents include, for example,polyvinyl alcohol, polyvinyl pyrrolidone, methyl cellulose, hydroxypropyl methylcellulose, hydroxyethyl cellulose, carboxymethyl cellulose,hydroxy propyl cellulose, chondroitin sulfate and salts thereof,hyaluronic acid and salts thereof, and combinations of the foregoing.Such agents are typically employed at a level between about 0.01% andabout 2% by weight.

Viscosity greater than that of simple aqueous solutions may be desirableto decrease variability in dispensing the formulations, to decreasephysical separation of components of a suspension or emulsion offormulation and/or otherwise to improve the formulation. Such viscositybuilding agents include, for example, polyvinyl alcohol, polyvinylpyrrolidone, methyl cellulose, hydroxy propyl methylcellulose,hydroxyethyl cellulose, carboxymethyl cellulose, hydroxy propylcellulose, chondroitin sulfate and salts thereof, hyaluronic acid andsalts thereof, combinations of the foregoing, and other agents known tothose skilled in the art. Such agents are typically employed at a levelbetween about 0.01% and about 2% by weight. Determination of acceptableamounts of any of the above adjuvants is readily ascertained by oneskilled in the art.

The pharmaceutical compositions may additionally include components toprovide sustained release and/or comfort. Such components include highmolecular weight, anionic mucomimetic polymers, gelling polysaccharides,and finely-divided drug carrier substrates. These components arediscussed in greater detail in U.S. Pat. Nos. 4,911,920; 5,403,841;5,212,162; and 4,861,760. The entire contents of these patents areincorporated herein by reference in their entirety for all purposes.

The pharmaceutical composition may be intended for intravenous use. Thepharmaceutically acceptable excipient can include buffers to adjust thepH to a desirable range for intravenous use. Many buffers includingsalts of inorganic acids such as phosphate, borate, and sulfate areknown.

Clemizole, a clemizole analog (including pharmaceutically acceptablesalts thereof) or a pharmaceutical composition thereof can be deliveredtransdermally, for treating the epilepsy disorders described herein, bya topical route, formulated as applicator sticks, solutions,suspensions, emulsions, gels, creams, ointments, pastes, jellies,paints, powders, and aerosols.

Clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof) can be provided as a salt in the pharmaceuticalcompositions described herein and can be formed with many acids,including but not limited to hydrochloric, sulfuric, acetic, lactic,tartaric, malic, succinic, etc. Salts tend to be more soluble in aqueousor other protonic solvents that are the corresponding free base forms.

Clemizole, a clemizole analog (including pharmaceutically acceptablesalts thereof) or a pharmaceutical composition thereof administered fortreating epilepsy disorders described herein may be administered viaparenteral administration, such as intravenous (IV) administration oradministration into a body cavity or lumen of an organ. The formulationsfor administration will commonly comprise a solution of the compositionsof the present invention dissolved in a pharmaceutically acceptablecarrier. Among the acceptable vehicles and solvents that can be employedare water and Ringer's solution, an isotonic sodium chloride. Inaddition, sterile fixed oils can conventionally be employed as a solventor suspending medium. For this purpose any bland fixed oil can beemployed including synthetic mono- or diglycerides. In addition, fattyacids such as oleic acid can likewise be used in the preparation ofinjectables. These solutions are sterile and generally free ofundesirable matter. These formulations may be sterilized byconventional, well known sterilization techniques. The formulations maycontain pharmaceutically acceptable auxiliary substances as required toapproximate physiological conditions such as pH adjusting and bufferingagents, toxicity adjusting agents, e.g., sodium acetate, sodiumchloride, potassium chloride, calcium chloride, sodium lactate and thelike. The concentration of the compositions of the present invention inthese formulations can vary widely, and will be selected primarily basedon fluid volumes, viscosities, body weight, and the like, in accordancewith the particular mode of administration selected and the patient'sneeds. For IV administration, the formulation can be a sterileinjectable preparation, such as a sterile injectable aqueous oroleaginous suspension. This suspension can be formulated according tothe known art using those suitable dispersing or wetting agents andsuspending agents. The sterile injectable preparation can also be asterile injectable solution or suspension in a nontoxicparenterally-acceptable diluent or solvent, such as a solution of1,3-butanediol.

The pharmaceutical formulations of clemizole or a clemizole analog(including pharmaceutically acceptable salts thereof) for treating anepilepsy disorder can be delivered by the use of liposomes which fusewith the cellular membrane or are endocytosed, i.e., by employingligands attached to the liposome, or attached directly to theoligonucleotide, that bind to surface membrane protein receptors of thecell resulting in endocytosis. By using liposomes, particularly wherethe liposome surface carries ligands specific for target cells, or areotherwise preferentially directed to a specific organ, one can focus thedelivery of the compositions of the present invention into the targetcells in vivo. (See, e.g., Al-Muhammed, J. Microencapsul. 13:293-306,1996; Chonn, Curr. Opin. Biotechnol. 6:698-708, 1995; Ostro, Am. J.Hosp. Pharm. 46:1576-1587, 1989).

Co-administration includes administering one active agent (e.g.clemizole or a clemizole analog (including pharmaceutically acceptablesalts thereof)) within 0.5, 1, 2, 4, 6, 8, 10, 12, 16, 20, or 24 hoursof a second active agent (e.g. an anticonvulsant). Co-administration mayinclude administering one active agent within 0.5, 1, 2, 4, 6, 8, 10,12, 16, 20, or 24 hours of a second active agent. Co-administration mayinclude administering two active agents simultaneously, approximatelysimultaneously (e.g., within about 1, 5, 10, 15, 20, or 30 minutes ofeach other), or sequentially in any order. Co-administration can beaccomplished by co-formulation, i.e., preparing a single pharmaceuticalcomposition including both active agents. In other embodiments, theactive agents can be formulated separately. The active and/or adjunctiveagents may be linked or conjugated to one another.

Co-administration also includes combination with treatments for epilepsydisorders such as dietary requirements or dietary changes. Accordingly,clemizole, a clemizole analog (including pharmaceutically acceptablesalts thereof) or a pharmaceutical composition thereof may beadministered to subjects on specialized diets, including but not limitedto, a ketogenic diet (e.g. a high-fat, adequate-protein,low-carbohydrate diet).

2. Effective Dosages

The pharmaceutical composition may include clemizole or a clemizoleanalog (including pharmaceutically acceptable salts thereof) containedin a therapeutically effective amount, i.e., in an amount effective toachieve its intended purpose. The actual amount effective for aparticular application will depend, inter alia, on the condition beingtreated. For example, when administered in methods to treat an epilepsydisorder (e.g. Dravet Syndrome), such compositions will contain amountsof clemizole, a clemizole analog (including pharmaceutically acceptablesalts thereof) or a pharmaceutical composition thereof effective toachieve the desired result (e.g. inhibiting seizures).

The dosage and frequency (single or multiple doses) of clemizole, aclemizole analog (including pharmaceutically acceptable salts thereof)or a pharmaceutical composition thereof administered can vary dependingupon a variety of factors, including route of administration; size, age,sex, health, body weight, body mass index, and diet of the recipient;nature and extent of symptoms of the disease being treated; presence ofother diseases or other health-related problems; kind of concurrenttreatment; and complications from any disease or treatment regimen.Other therapeutic regimens or agents can be used in conjunction with themethods described herein.

The therapeutically effective amounts of clemizole, a clemizole analog(including pharmaceutically acceptable salts thereof) or apharmaceutical composition thereof for treating epilepsy diseasesdescribed herein may be initially determined from cell culture assays.Target concentrations will be those concentrations of clemizole, aclemizole analog (including pharmaceutically acceptable salts thereof)or a pharmaceutical composition thereof capable of inhibiting orotherwise decreasing seizures experienced by a patient.

Therapeutically effective amounts of clemizole, a clemizole analog(including pharmaceutically acceptable salts thereof) or apharmaceutical composition thereof for use in humans may be determinedfrom animal models. For example, a dose for humans can be formulated toachieve a concentration that has been found to be effective in animals.The dosage in humans can be adjusted by monitoring response of thepatient to the treatment and adjusting the dosage upwards or downwards,as described above.

Dosages may be varied depending upon the requirements of the subject andthe compound being employed. The dose administered to a subject, in thecontext of the pharmaceutical compositions presented herein, should besufficient to effect a beneficial therapeutic response in the subjectover time. The size of the dose also will be determined by theexistence, nature, and extent of any adverse side effects. Generally,treatment is initiated with smaller dosages, which are less than theoptimum dose of the compound. Thereafter, the dosage is increased bysmall increments until the optimum effect under circumstances isreached.

Dosage amounts and intervals can be adjusted individually to providelevels of the administered clemizole, a clemizole analog (includingpharmaceutically acceptable salts thereof) or a pharmaceuticalcomposition thereof effective for the particular epilepsy disorder beingtreated. This will provide a therapeutic regimen that is commensuratewith the severity of the individual's disease state.

Utilizing the teachings provided herein, an effective prophylactic ortherapeutic treatment regimen can be planned that does not causesubstantial toxicity and yet is entirely effective to treat the clinicalsymptoms demonstrated by the particular patient. This planning shouldinvolve the careful choice of clemizole, a clemizole analog (includingpharmaceutically acceptable salts thereof) or a pharmaceuticalcomposition thereof by considering factors such as potency, relativebioavailability, patient body weight, presence and severity of adverseside effects, preferred mode of administration, and the toxicity profileof the selected agent.

3. Toxicity

The ratio between toxicity and therapeutic effect for a particularcompound is its therapeutic index and can be expressed as the ratiobetween LD₅₀ (the amount of compound lethal in 50% of the population)and ED₅₀ (the amount of compound effective in 50% of the population).Compounds that exhibit high therapeutic indices are preferred.Therapeutic index data obtained from cell culture assays and/or animalstudies can be used in formulating a range of dosages for use in humans.The dosage of such compounds preferably lies within a range of plasmaconcentrations that include the ED₅₀ with little or no toxicity. Thedosage may vary within this range depending upon the dosage formemployed and the route of administration utilized. See, e.g. Fingl etal., In: THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, Ch. 1, p. 1, 1975.The exact formulation, route of administration, and dosage can be chosenby the individual physician in view of the patient's condition and theparticular method in which the compound is used.

When parenteral application is needed or desired, particularly suitableadmixtures for clemizole or a clemizole analog (includingpharmaceutically acceptable salts thereof) included in thepharmaceutical composition may be injectable, sterile solutions, oily oraqueous solutions, as well as suspensions, emulsions, or implants,including suppositories. In particular, carriers for parenteraladministration include aqueous solutions of dextrose, saline, purewater, ethanol, glycerol, propylene glycol, peanut oil, sesame oil,polyoxyethylene-block polymers, and the like. Ampoules are convenientunit dosages. Pharmaceutical admixtures suitable for use in thepharmaceutical compositions presented herein may include thosedescribed, for example, in Pharmaceutical Sciences (17th Ed., Mack Pub.Co., Easton, Pa.) and WO 96/05309, the teachings of both of which arehereby incorporated by reference.

III. EXAMPLES Example 1

Epilepsy can be acquired as a result of an injury to the brain orgenetic mutation. Among the genetic epilepsies more than 650 variantshave been identified in the SCN1A gene (Harkin, L. A. et al. Thespectrum of SCN1A-related infantile epileptic encephalopathies. Brain130, 843-852 (2007); Mulley J. C., et al., SCN1A mutations and epilepsy.Hum. Mutat. 25, 535-542 (2005)). Missense or frame-shift mutations inthis gene are associated with generalized epilepsy with febrile seizuresplus (GEFS+) (Ceulemans, B. P., et al., Clinical correlations ofmutations in the SCN1A gene: from febrile seizures to severe myoclonicepilepsy in infancy. Pediatric Neurol. 30, 236-243 (2004)) as well as amore severe disorder known as Dravet syndrome. Children with DSinitially exhibit normal development but often experience febrileseizure episodes within the first year of life with eventual progressionto severe spontaneous recurrent seizures, intellectual disability,ataxia, and psychomotor dysfunction. Seizures are inadequately managedusing available antiepileptic drugs (AEDs) and these children are poorcandidates for neurosurgical resection (Bender, A. C., et al., SCN1Amutations in Dravet syndrome: Impact of interneuron dysfunction onneural networks and cognitive outcome. Epilepsy Beh. 23, 177-186(2012)).

In mammalian brain there are four main subtypes of voltage-gated sodiumchannel alpha subunits: Na_(V)1.1, Na_(V)1.2, Na_(V)1.3 and Na_(V)1.6,encoded for by the genes SCN1A, SCN2A, SCN1A, and SCN1A, respectively.Opening of these channels produces a sodium conductance and rapid cellmembrane depolarization e.g., features integral to action potentialinitiation (Catterall, W. A., et al., Na_(v)1.1 channels and epilepsy.J. Physiol. 588, 1849-1859 (2010)). In mice, Na_(v)1.1 is widelyexpressed in the central nervous system including the axon initialsegment of parvalbumin-positive hippocampal interneurons and excitatoryprincipal cells (Kim, D. Y., et al., Reduced sodium channel Na(v)1.1levels in BACE1-null mice. J. Biol. Chem. 286, 8106-8116 (2011); Chen,C., et al., Mice lacking sodium channel beta1 subunits display defectsin neuronal excitability, sodium channel expression, and nodalarchitecture. J. Neurosci. 24, 4030-4042 (2004)). Heterozygous deletionof Na_(v)1.1 in mice leads to a reduction in the firing capability ofacutely dissociated fast-spiking interneurons (Yu, F. H., et al.,Reduced sodium current in GABAergic interneurons in a mouse model ofsevere myoclonic epilepsy in infancy. Nat. Neurosci. 9, 1142-1149(2006)). Mice with global or interneuron-specific heterozygous deletionof Na_(v)1.1 exhibit temperature-induced and spontaneous seizures, mildataxia, autism-like behaviors and premature death (Yu, F. H., et al.,Reduced sodium current in GABAergic interneurons in a mouse model ofsevere myoclonic epilepsy in infancy. Nat. Neurosci. 9, 1142-1149(2006); Oakley, J. C., et al., Temperature- and age-dependent seizuresin a mouse model of severe myoclonic epilepsy in infancy. Proc. Natl.Acad. Sci. USA 106, 3994-3999 (2009); Cheah, C. S., et al., Specificdeletion of Na_(v)1.1 sodium channels in inhibitory interneurons causesseizures and premature death in a mouse model of Dravet syndrome. Proc.Natl. Acad. Sci. USA 109, 14646-14651 (2012)). Knock-in mouse carrying apremature stop codon in domain III of the Na_(v)1.1 channel also exhibita decrement in spike amplitude during prolonged interneuron firing andincreased sensitivity to temperature-induced seizures (Ogiwara, I., etal., Na_(v)1.1 localizes to axons of parvalbumin-positive inhibitoryinterneurons: a circuit basis for epileptic seizures in mice carrying anScn1a gene mutation. J. Neurosci. 27, 5903-5914 (2007)).

Generation and characterization of valid animal models is critical toefforts to understand the pathophysiology of DS, and to aid inidentification of novel therapies. While considerable attention hasfocused on modeling SCN1A mutations in mice these animals have provendifficult to breed and epilepsy phenotypes are strongly influenced bybackground strain genetics. Induced pluripotent stem cells can begenerated from DS patients but individual neurons do not recapitulatethe network environment necessary for in vivo seizure generation. Daniorerio (zebrafish), a simple vertebrate species, provide an alternativemodel system with significant advantages for genetic manipulation,cost-efficient breeding and in vivo drug discovery (Lessman, C. A., Thedeveloping zebrafish (Danio rerio): a vertebrate model forhigh-throughput screening of chemical libraries. Birth Defects Res. C.Embryo Today 93, 268-280 (2011); Delvecchio, C., et al., The zebrafish:a powerful platform for in vivo, HTS drug discovery. Assay Drug Dev.Technol. 9, 354-361 (2011); Rinkwitz, S., et al., Zebrafish: anintegrative system for neurogenomics and neurosciences. Prog. Neurobiol.93, 231-243 (2011)). Ideally, an animal model should be based on a knowngenetic cause of the disease (SCN1A mutation), accurately recapitulatekey features of the disease (epilepsy), and respond, or not, totherapies commonly used in patients with the disease (pharmacologicalvalidation). If successful, such a model could inform the understandingof the disease process and catalyze explorations toward new therapies.

In zebrafish, the voltage-gated sodium channel family consists of foursets of duplicated genes: scn1Laa & scn1Lab, scn4aa & scn4ab, scn5Laa &scn5Lab, and scn8aa & scn8ab (Novak, A. E., et al., Embryonic and larvalexpression of zebrafish voltage-gated sodium channel alpha-subunitgenes. Dev. Dyn. 235, 1962-1973 (2006)). The zebrafish scn1Lab geneshares a 77% identity with human SCN1A and is expressed in the centralnervous system. A homozygous zebrafish mutant for this gene (originallytermed didy^(s552)) was discovered in a chemical mutagenesis screenusing the optokinetic response as an assay (Schoonheim, P. J.,Arrenberg, A. B., Del Bene, F., & Baier H., Optogenetic localization andgenetic perturbation of saccade-generating neurons in zebrafish. J.Neurosci. 30, 7111-7120 (2010)). These types of screens are based oninducing random point mutations using the alkylating agentN-ethyl-N-nitrosourea (ENU), resulting mutations are typicallyloss-of-function and recessive. Although this is a homozygous mutation,scn1Lab zebrafish mutants are relevant for the autosomal dominant humanDravet Syndrome given the genome duplication in zebrafish and thepresence of an additional Na_(v)1.1 homologue (scn1Laa). scn1Lab mutantswere characterized at the molecular and behavioral level, demonstratedthat mutants exhibit spontaneous drug-resistant seizures, and then usedthem in a novel high-throughput screening program to identify compoundsthat ameliorate the epilepsy phenotype. A phenotype-based screenidentified clemizole, an FDA-approved compound, as an effectiveinhibitor of spontaneous convulsive behaviors and electrographicseizures in these mutants.

scn1Lab Expression and Characterization of Mutant Zebrafish

Zebrafish with a mutation in domain III of a voltage-gated sodiumchannel were identified by Dr. Herwig Baier during a chemicalmutagenesis screen (Schoonheim, P. J., Arrenberg, A. B., Del Bene, F., &Baier H., Optogenetic localization and genetic perturbation ofsaccade-generating neurons in zebrafish. J. Neurosci. 30, 7111-7120(2010)). Original scn1Lab mutants were backcrossed onto the Tupfel long(TL) background for 7-10 generations and confirmed a methionine (M) toarginine (R) mutation in the colony (FIG. 1A). Reverse transcriptase(RT) and quantitative (q) PCR revealed a decrease in mRNA expression forscn1Lab in mutant larvae at 3, 5 and 7 days post-fertilization (dpf)(FIG. 1B); antibodies recognizing this protein in zebrafish are notavailable. As expected (Novak, A. E., et al., Embryonic and larvalexpression of zebrafish voltage-gated sodium channel alpha-subunitgenes. Dev. Dyn. 235, 1962-1973 (2006)), scn1Lab is prominentlyexpressed during early stages of larval development (FIG. 1B) andspecifically in the central nervous system at 3 dpf (FIGS. 1D, 1E).Whole-mount in situ hybridization revealed diffuse but prominentexpression in brain regions corresponding to forebrain (telencephalon),optic tectum and cerebellum. A similar expression pattern was observedfor scn1Laa at 3 dpf. At 5 and 7 dpf, CNS expression remained prominentand faint scn1Lab signal was also noted in the heart (FIG. 1D). Relativeexpression of scn8aa or scn8ab (Na_(v)1.6) e.g., a subunit thought toact as a genetic modifier of DS (Martin, M. S., et al., Thevoltage-gated sodium channel Scn8a is a genetic modifier of severemyoclonic epilepsy of infancy. Hum. Mol. Gen. 16, 2892-2899 (2007)),failed to reveal a significant difference in expression between mutantsand sibling controls at 5 dpf (FIG. 1C). Similarly, microarray analysisat 5 dpf also failed to detect a compensatory change in the mRNAexpression of thirteen different zebrafish scn subunits (Table I)including the other homolog (scn1Laa). These results demonstrate aselective defect in a zebrafish Na_(v)1.1 gene expressed in the CNSduring early development.

Large-Scale Transcriptomic Analysis of scn1Lab Mutants.

Although inherited disorders of voltage-gated ion channels arerecognized as an etiology of epilepsy, investigation of transcriptionalchanges has not been reported for any epilepsy-related channelopathy. Todetect differences in gene expression in an unbiased manner an AgilentDanio rerio chip covering ˜44,000 probes (FIGS. 2A, 2B) was used.Hierarchical clustering analyses showed that ˜2.5% (1099) of theseprobes were differentially expressed between mutants and siblingcontrols at 5 dpf (p≦0.01, t test; 674 up-regulated and 425down-regulated); 405 were assigned to an “unknown function” category. Alist of 30 down- and up-regulated known genes showing the greatestdifferences in expression is shown in FIG. 2C. These differences weremodest as 90% (990/1099) of the identified genes exhibited fold-changesbetween 0.8 and 2.0. Similar to microarray analysis of Mecp2 single-genemutant mice (Jordan, C., et al., Cerebellar gene expression profiles ofmouse models for Rett syndrome reveal novel MeCP2 targets. BMC Med.Genet. 8, 36 (2007)), many of the genes identified had no obviousCNS-related function and/or expression.

The two largest fold-changed genes, somatolactin β and a Na, K-ATPase,have expression primarily restricted to the pituitary (smt1b) (Lopez,M., et al., Expression of the somatolactin β gene during zebrafishembryonic development. Gene Expr. Patterns 6, 156-161 (2006)) or ear,intestinal bulb and pronephric duct (atp1a1a.5) (Blasiole, B., et al.,Cloning, mapping, and developmental expression of a sixth zebrafish Na,K-ATPase alpha1 subunit gene (atp1a1a.5). Mech. Dev. 119, Suppl1:S211-S214 (2002)). Probes for several genes related to apoptosis(casp8, casp8b and casp3b) did not reveal any statistically significantchanges in the microarray studies. Of the genes with altered expressionin scn1Lab mutants, six were previously implicated in neurologicaldisorders e.g., pcdh19 (infantile epileptic encephalopathy), cyfip1 andfxr2 (Fragile X syndrome), ocrl (Lowe syndrome), ubap2l (Parkinson'sdisease) and oca2 (Angelman syndrome). Microarray-based gene expressionmeasurements were verified for 14 randomly selected genes using qPCR(FIG. 3A).

Biological functions were assigned to all genes using gene ontology (GO)annotations and the 482 genes showing at least a 1.5-fold change inexpression and a p value <0.01 were categorized further (FIG. 3C).Calcium ion binding genes include annexinA1c, A1b and 2a, spectrin α2,neurexin 2a, calsyntenin 1 and parvalbumin 3. Significant changes in agap junction channel (cx43), a gene involved in clustering ofvoltage-gated sodium channels at the axon initial segment (spna2) andthe ubiquitin domain of a GABA receptor (map1lc3b) were also noted.Three additional genes not found on the microarray were chosen for qPCRanalysis (FIG. 3B): hcn1, a gene shown to be correlated with SCN1A usingdata mining and down-regulated in several seizure models (Noam, Y., etal., Towards an integrated view of HCN channel role in epilepsy. Curr.Opin. Neurobiol. 21, 873-879 (2011)) was significantly reduced inscn1Lab mutants compared to sibling control (p<0.05 2-tail Student'st-test). However, homer and bdnf e.g., genes involved in synaptogenesisrelated to the formation of recurrent excitatory synapses and epilepsy(Avedissian, M., et al., Hippocampal gene expression analysis using theORESTES methodology shows that homer 1a mRNA is upregulated in the acuteperiod of the pilocarpine epilepsy model. Hippocampus 17, 130-136(2007); Tongiorgi, E., et al., Brain-derived neurotrophic factor mRNAand protein are targeted to discrete dendritic laminas by events thattrigger epileptogenesis. J. Neurosci. 24, 6842-6852 (2004)) wereunchanged.

Spontaneous Seizures in scn1Lab Mutant Zebrafish

scn1Lab mutants were monitored for evidence of spontaneouselectrographic seizures starting at 3 dpf e.g., the first larval stageat which epileptiform discharge can be detected (Baraban, S. C., et al.,A large-scale mutagenesis screen to identify seizure-resistantzebrafish. Epilepsia 48, 1151-157 (2007); Hortopan, G. A., et al.,Spontaneous seizures and altered gene expression in GABA signalingpathways in a mind bomb mutant zebrafish. J. Neurosci. 30, 13718-13728(2010); Hunt, R. F., Hortopan, G. A., Gillespie, A., & Baraban, S. C., Anovel zebrafish model of hyperthermia-induced seizures reveals a rolefor TRPV4 channels and NMDA-type glutamate receptors. Exp. Neurol. 237,199-206 (2012); Baraban, S. C., Taylor, M. R., Castro, P. A., & BaierH., Pentylenetetrazole induced changes in zebrafish behavior, neuralactivity and c-fos expression. Neuroscience 131, 759-768 (2005); Chege,S. W., Hortopan, G. A., Dinday, M. T., & Baraban, S. C., Expression andfunction of KCNQ channels in larval zebrafish. Dev. Neurobiol. 72,186-198 (2012)). Mutant larvae were identified by their “black”appearance (FIG. 4A), which is indicative of a defect in pigmentaggregation and die prematurely between 10 and 12 dpf, as reportedpreviously (Novak, A. E., et al., Embryonic and larval expression ofzebrafish voltage-gated sodium channel alpha-subunit genes. Dev. Dyn.235, 1962-1973 (2006)). Forebrain extracellular field recordings fromparalyzed and agar-immobilized scn1Lab mutants were marked by frequentbrief interictal-like bursts and large-amplitude long durationictal-like events starting at 3 dpf (n=4) and progressively becomingmore prominent between 4 and 7 dpf (n=132) (FIG. 2C). These events wereconfirmed in 100% of mutants at 3 dpf, 100% at 4 dpf, 97% at 5 dpf, 98%at 6 dpf and 100% at 7 dpf.

Abnormal electrical events were not observed in age-matched siblingcontrols at any developmental stage (n=36). Hyperthermia-inducedseizures (Hunt, R. F., Hortopan, G. A., Gillespie, A., & Baraban, S. C.,A novel zebrafish model of hyperthermia-induced seizures reveals a rolefor TRPV4 channels and NMDA-type glutamate receptors. Exp. Neurol. 237,199-206 (2012)) could be evoked in 5 dpf scn1Lab mutants and controls atapparently similar temperature thresholds (mutant: 26.9±0.5 C.°; n=14;control: 25.9±0.5 C.°; n=14; p=0.164 t-test). However, thesemeasurements were complicated, in mutants, by simultaneous occurrence ofhigh frequency spontaneous epileptiform discharges. Mutants had elevatedlevels of swim activity and exhibited unprovoked seizure-like behaviorconsisting of whole-body convulsions and rapid undirected movementstarting at 4 dpf (n=36). A representative locomotion tracking plot of ascn1Lab mutant showing hyperactivity and convulsive behavior is shown inFIG. 4B. This behavior is similar to that classified as a Stage IIIseizure in larvae exposed to pentylenetetrazole (Baraban, S. C., Taylor,M. R., Castro, P. A., & Baier H., Pentylenetetrazole induced changes inzebrafish behavior, neural activity and c-fos expression. Neuroscience131, 759-768 (2005)). Seizure behaviors were never observed in controlsat any stage of development (n=36). In pools of mutant and siblingcontrol larvae, scn1Lab mutants stay close to the sides of the petridish, which is considered a form of thigmotaxis in fish (Ellis, L. D.,Seibert, J., & Soanes, K. H., Distinct modes of induced hyperactivity inzebrafish larvae. Brain Res. 1449, 46-59 (2012)). These results reveal astriking epilepsy phenotype in scn1Lab mutant zebrafish.

Pharmacological Evaluation of scn1Lab Mutant Zebrafish

Seizures associated with SCN1A mutations are poorly responsive to mostAEDs To evaluate pharmaco-sensitivity spontaneous electrographicseizures were recorded in agar-embedded scn1Lab mutants (5-6 dpf) underbaseline conditions, and again after application of a commerciallyavailable AED. All drugs were bath applied at a concentration of 1 mM;seven fish were tested for each drug. Epileptiform event frequency(including interictal- and ictal-like discharges) and the fractionaltime spent seizing in scn1Lab mutants were reduced by valproate,diazepam, potassium bromide and stiripentol (FIGS. 5A, 5B, 5D). Burstdurations were not significantly changed for any of these drug exposures(FIG. 5C).

As expected, most AEDs had no effect and epileptiform activity becamemore frequent following exposure to carbamazepine (in 2 of 7 fish),ethosuximide (4 of 7 fish) or vigabatrin (6 of 7 fish). Because DSchildren often respond to the ketogenic diet (KD) (Dravet, C., et al.,Severe myoclonic epilepsy in infancy: Dravet syndrome. Adv. Neurol. 95,71-102 (2005)) a separate clutch of scn1Lab mutants was exposed,siblings and WT controls to a form of the diet for 48 hr starting at 4dpf. Locomotion tracking data on KD-exposed larvae at 6 dpf confirm areduction in seizure-like behavior to control levels in 7 of 10 mutants(FIG. 5E; mean velocity, treated mutants=0.43±0.09 mm/sec, n=16;un-treated mutants=0.81±0.05 mm/sec, n=28; p<0.05 Kruskal-Wallis ANOVAon Ranks with a Dunn's pairwise multiple comparison). No significantdifferences in swim behavior were noted in sibling controls treated withthe KD (mean velocity=0.63±0.05 mm/sec, n=20) compared to un-treated WTlarvae at 6 dpf (mean velocity=0.62±0.07 mm/sec; n=20). Acute exposure(20 min) to the diet had no effect on mutant seizure behavior in thelocomotion assay (n=14; change in mean velocity <34%). Subsequentforebrain field recordings obtained from the same zebrafish used in thelocomotion assay (FIG. 5F, top trace) confirmed the occurrence ofspontaneous epileptiform discharge for embryo media exposed scn1Labmutants and a suppression of burst activity in mutants exposed to the KDfor 48 hr (FIG. 5F, bottom trace). These results demonstrate that thepharmacological profile for scn1Lab mutants resembles that seen inchildren with DS.

High-Throughput Drug Screening in scn1Lab Mutants

Because behavioral seizure activity is easily and rapidly monitoredusing a locomotion tracking format (Baraban, S. C., et al., Alarge-scale mutagenesis screen to identify seizure-resistant zebrafish.Epilepsia 48, 1151-157 (2007); Hortopan, G. A., et al., Spontaneousseizures and altered gene expression in GABA signaling pathways in amind bomb mutant zebrafish. J. Neurosci. 30, 13718-13728 (2010);Baraban, S. C., Taylor, M. R., Castro, P. A., & Baier H.,Pentylenetetrazole induced changes in zebrafish behavior, neuralactivity and c-fos expression. Neuroscience 131, 759-768 (2005); Chege,S. W., Hortopan, G. A., Dinday, M. T., & Baraban, S.C., Expression andfunction of KCNQ channels in larval zebrafish. Dev. Neurobiol. 72,186-198 (2012); Berghmans, S., Hunt, J., Roach, A., & Goldsmith, P.,Zebrafish offer the potential for a primary screen to identify a widevariety of potential anticonvulsants. Epilepsy Res. 75, 18-28 (2007);Baxendale, S., et al., Identification of compounds with anti-convulsantproperties in a zebrafish model of epileptic seizures. Dis. Model. Mech.5, 773-774 (2012); Cario, C. L., Farrell, T. C., Milanese, C., & Burton,E. A., Automated measurement of zebrafish larval movement. J. Physiol.589, 3703-3708 (2011); Winter, M. J., et al., Validation of a larvalzebrafish locomotor assay for assessing the seizure liability ofearly-stage development drugs. J. Pharm. Tox. Methods 5, 176-187 (2008);Orellana-Paucar, A. M., et al., Anticonvulsant activity of bisabolenesesquiterpenoids of Curcuma longa in zebrafish and mouse seizure models.Epilepsy Beh. 24, 14-22 (2012) (FIGS. 4B and 5B1).

A high-throughput phenotype-based strategy was designed to screenchemical libraries for compounds that reduce mutant behavior to Stage 0(very little swim activity) or Stage I (increased, but non-convulsive,swim activity) e.g., behavior equivalent to that seen in normal WTmutants. Automated measurement of larval activity was achieved usingETHOVISION® tracking software (Noldus Information Technology) and ahigh-speed camera. Previous studies confirmed that high velocitymovement ≧20 mm/sec correspond to paroxysmal seizure-like convulsions(Stage III) (Winter, M. J., et al., Validation of a larval zebrafishlocomotor assay for assessing the seizure liability of early-stagedevelopment drugs. J. Pharm. Tox. Methods 5, 176-187 (2008);Orellana-Paucar, A. M., et al., Anticonvulsant activity of bisabolenesesquiterpenoids of Curcuma longa in zebrafish and mouse seizure models.Epilepsy Beh. 24, 14-22 (2012)).

Using a 96-well format, mutant swim activity at baseline wasautomatically tracked, and then again after addition of a test compound(100 μl); each compound was tested on 6 to 12 individual larvae at 5dpf. The change in mutant swim activity between two consecutiverecording epochs in embryo media was taken as baseline and is shown inFIG. 6A (n=28). Based on a standard deviation of 17.3 for baselinerecordings associated simply with a solution exchange, compounds thatinhibited movement (measured as a change in mean velocity) by ≧34% werescreened for. To validate this approach, eleven AEDs and the KD werefirst screened using this assay. As expected from electrophysiologicalassays (FIGS. 5A-5F), diazepam, potassium bromide, stiripentol,valproate and a 48 hr exposure to KD effectively inhibited seizurebehavior in the locomotion-based assay (FIG. 6B); ganaxolone, aneuroactive steroid related to allopregnalone, was also effective. Next,test compounds were screened at an initial concentration of 667 μM froma library that included US Food and Drug Administration (FDA) approvedand toxicology tested drugs.

Among the 320 compounds screened in vivo, 18 were found to significantlyinhibit spontaneous seizures in scn1Lab mutants to levels comparable toStage 0 or Stage I behavior and/or reduce mean swim velocity (circles inFIG. 6C). These 18 compounds were then re-tested on a separate clutch ofscn1Lab mutants at concentrations of 667, 67 and 6.7 μM. In the initialscreen, 81 compounds were identified as lethal i.e., no visibleheartbeat or movement in response to touch after a 30 min exposure andwere re-evaluated at a dilution of 1:100; none of these advancedfurther. The drug library included a number of additional compounds withputative anticonvulsant properties (beclamide, aminohydroxybutyric acid,and tiletamine) that were also ineffective in the 96-well locomotionassay at 667 μM. 14 of the re-tested compounds either failed tosuccessfully inhibit seizure behavior in a second clutch of scn1Labmutants or only suppressed behavior at the highest drug concentration.Next 4 (out of 18) compounds that were effective in reducingseizure-induced swim activity and mean velocity at all three drugconcentrations for further testing were selected: zoxazolamine,clemizole HCl, clorgiline HCl and tolperisone HCl (FIG. 6D). Each ofthese compounds was evaluated a third time in the locomotion assay at aconcentration of 100 μM, and subsequently monitored for forebrainelectrographic activity. Clorgiline (a monoamine oxidase A inhibitor)and the muscle relaxants zoxazolamine (Hadra, R. & Millichap J. G.,Quantitative assessment of motor function in cerebral palsy: evaluationof zoxazolamine (flexin), a new muscular relaxant agent. Neurology 6,843-852 (1956)) and tolperisone (Sakitama, K., The effects of centrallyacting muscle relaxants on the intrathecal noradrenaline-inducedfacilitation of the flexor reflex mediated by group II afferent fibersin rats. Jpn. J Pharmacol. 63, 369-736 (1993)) were identified as “falsepositives” because they reduced swim activity at this concentration butwhen the same mutant was embedded in agar electrographic seizure eventswere still observed (see FIG. 6E).

Only one compound, clemizole (antihistamine and NS4B RNA bindinginhibitor) (Finkelstein, M., Kromer, C. M., Sweeney, S. A., & DelahuntC. S., Some aspects of the pharmacology of clemizole hydrochloride. J.Am. Pharm. Assoc. Am. Pharm. Assoc. 49, 18-22 (1960); Einav, S., Sobol,H. D., Gehrig, E., & Glenn J. S., Discovery of a hepatitis C target andits pharmacological inhibitors by microfluidic affinity analysis. Nat.Biotechnol. 26, 1019-1027 (2008)), was effective in suppressingspontaneous seizure activity in both assays (FIGS. 6D-6E). Clemizole hadno significant effect on seizure behavior in the locomotion assay atconcentrations between 6.25 and 50 μM (n=33). As an additionalevaluation of the therapeutic potential for acute clemizole treatment,it was demonstrated that 100 μM clemizole was effective in reducingseizure behavior in WT zebrafish exposed to 15 mM pentylenetetrazole(FIG. 6D; n=10) i.e., a model of acute seizures based on GABA receptorantagonism. These results suggest that scn1Lab mutants can be used in ahigh-throughput screen to identify potential lead compounds for Dravetsyndrome.

The scn1Lab zebrafish mutant described here is the first simplevertebrate model of a sodium channel mutation that recapitulatesfeatures of Dravet syndrome, a catastrophic form of drug-resistantepilepsy in children. These mutants exhibit hyperactivity, includingconvulsive behavior, spontaneous electrographic seizures, shortenedlifespan and a pharmacological profile similar to the human condition.Additional molecular analysis of scn1Lab mutants suggests the absence ofgross changes in global gene expression and a lack of compensation, atthe RNA level, by other voltage-gated Na⁺ channel subunits. A two-stagephenotype-based drug screening strategy to identify lead compounds withthe potential to ameliorate epilepsy phenotypes associated with SCN1Amutation identified one FDA-approved drug (clemizole).

Electroencephalographic (EEG) activity is typically normal in the firstyear of life for DS patients with an evolution to abnormal paroxysmaland polyspike activity between 1 and 9 years of age. This age-dependentpattern was mimicked in developing zebrafish larvae at ages where scn1aexpression was significant. Forebrain extracellular recordings in veryyoung larvae (3 dpf) appeared largely normal with the occasional smallburst of polyspike activity. Frequent brief interictal-like activitywith large amplitude polyspike burst discharges became more prominent aslarvae aged. The architecture of these electrical events resembled thosepreviously described in wild-type larvae exposed to pentylenetetrazole(Baraban, S. C., Taylor, M. R., Castro, P. A., & Baier H.,Pentylenetetrazole induced changes in zebrafish behavior, neuralactivity and c-fos expression. Neuroscience 131, 759-768 (2005)),4-aminopyridine (Baraban, S. C., et al., A large-scale mutagenesisscreen to identify seizure-resistant zebrafish. Epilepsia 48, 1151-157(2007)), linopirdine (Chege, S. W., Hortopan, G. A., Dinday, M. T., &Baraban, S.C., Expression and function of KCNQ channels in larvalzebrafish. Dev. Neurobiol. 72, 186-198 (2012)) or hyperthermia (Hunt, R.F., Hortopan, G. A., Gillespie, A., & Baraban, S. C., A novel zebrafishmodel of hyperthermia-induced seizures reveals a role for TRPV4 channelsand NMDA-type glutamate receptors. Exp. Neurol. 237, 199-206 (2012)).

The appearance of electrographic seizure activity corresponds withhyperactivity, full-body convulsions with associated high-velocity swimactivity and brief loss-of-posture in freely behaving mutants. Thesetypes of spontaneous behaviors are never observed in wild-type larvaeand, again, resemble those previously observed only during exposure toconvulsant drugs. These behaviors are an indirect indicator of seizureactivity and could be used for rapid in vivo evaluation of drugtreatments and lethality in a multi-well format using automatedlocomotion tracking software (Berghmans, S., Hunt, J., Roach, A., &Goldsmith, P., Zebrafish offer the potential for a primary screen toidentify a wide variety of potential anticonvulsants. Epilepsy Res. 75,18-28 (2007); Baxendale, S., et al., Identification of compounds withanti-convulsant properties in a zebrafish model of epileptic seizures.Dis. Model. Mech. 5, 773-774 (2012); Winter, M. J., et al., Validationof a larval zebrafish locomotor assay for assessing the seizureliability of early-stage development drugs. J. Pharm. Tox. Methods 5,176-187 (2008)). Seizures in scn1Lab zebrafish mutants were responsiveto the ketogenic diet and four AEDs (e.g., valproate, benzodiazepine,potassium bromide and stiripentol) prescribed clinically for patientswith DS.

Interestingly, electrographic seizure events in scn1Lab mutants remainedunchanged (or perhaps worsened) in response to several commerciallyavailable AEDs. While it is possible that drug concentrations higherthan 1 mM could be required to abolish electrical events, these would beconsidered high and potentially non-selective concentrations. In drugtrials using an acute PTZ-induced seizure model in larval zebrafish(Baraban, S. C., et al., A large-scale mutagenesis screen to identifyseizure-resistant zebrafish. Epilepsia 48, 1151-157 (2007); Berghmans,S., Hunt, J., Roach, A., & Goldsmith, P., Zebrafish offer the potentialfor a primary screen to identify a wide variety of potentialanticonvulsants. Epilepsy Res. 75, 18-28 (2007); Baxendale, S., et al.,Identification of compounds with anti-convulsant properties in azebrafish model of epileptic seizures. Dis. Model. Mech. 5, 773-774(2012); Afrikanova, T., et al., Validation of the zebrafishpentylenetetrazol seizure model: locomotor versus electrographicresponses to antiepileptic drugs. PLoS One 8, e54166 (2013)), AEDconcentrations of 1 mM and below were often sufficient for assessingantiepileptic activity. With a failure to respond to seven differentAEDs this model fits the clinical definition of drug-resistant epilepsy(de Toffol, B., et al., ESPERA study: Applicability of the new ILAEcriteria for antiepileptic drug resistance of focal epilepsies incurrent clinical practice. Epilepsy Beh 25, 166-169 (2012)).

For nearly 40 years, the discovery and identification of new AEDs hasalmost entirely been based upon preclinical animal models of acquired oracute seizures in rodents (Loscher, W. & Schmidt, D., Modernantiepileptic drug development has failed to deliver: Ways out of thecurrent dilemma. Epilepsia 52, 657-658 (2011)). This approachsuccessfully identified drugs that block generalized tonic-clonicseizures in humans (Bialer, M. & White H. S., Key factors in thediscovery and development of new antiepileptic drugs. Nat. Rev. DrugDiscov. 9, 10-19 (2012)) but remains time-consuming, resource intensive,expensive and laborious. While testing against PTZ or other types ofacquired seizures in zebrafish larvae may be more efficient than similarassays in rodents (Berghmans, S., Hunt, J., Roach, A., & Goldsmith, P.,Zebrafish offer the potential for a primary screen to identify a widevariety of potential anticonvulsants. Epilepsy Res. 75, 18-28 (2007);Baxendale, S., et al., Identification of compounds with anti-convulsantproperties in a zebrafish model of epileptic seizures. Dis. Model. Mech.5, 773-774 (2012) Afrikanova, T., et al., Validation of the zebrafishpentylenetetrazol seizure model: locomotor versus electrographicresponses to antiepileptic drugs. PLoS One 8, e54166 (2013)), theyultimately should identify the same classes of compounds.

In contrast, here is described an alternative screening strategy using a96-well format for rapid automated behavioral monitoring followed by asensitive electrophysiological assay of spontaneous electrographicseizure activity in a mutant fish mimicking a known human geneticdisorder. This in vivo strategy simultaneously monitors lethality and isnot limited to SCN1A, but could be applied to any epilepsy disorder.Indeed, this phenotype-based approach could form the basis of agenetically informed or “personalized” approach to drug discovery. Whilegenetically modified mice mimicking known SCN1A mutations and exhibitingepilepsy have been developed, breeding can be complicated, backgroundstrain can modify seizure phenotypes and AEDs are rarely tested in theseanimals. For example, in Scn1a^(RX/+) mutant mice stiripentol andclobazam were only evaluated for effects on hyperthermia-induced seizurethresholds (Cao, D., et al., Efficacy of stiripentol inhyperthermia-induced seizures in a mouse model of Dravet syndrome.Epilepsia 53, 1140-1145 (2012)). Treatment of Scn1a^(+/−) mutant micewith clonazepam, an allosteric modulator of GABA-A receptors, rescuedsome of the autistic-like behaviors but was not evaluated as anantiepileptic (de Toffol, B., et al., ESPERA study: Applicability of thenew ILAE criteria for antiepileptic drug resistance of focal epilepsiesin current clinical practice. Epilepsy Beh 25, 166-169 (2012)).

Where drug-resistant rodent epilepsy models have been described, such asthe subgroup of wild-type rats selected from kindling or post-statusepilepticus models (Han, S., et al., Autistic-like behaviour in Scn1a+/−mice and rescue by enhanced GABA-mediated neurotransmission. Nature 489,385-390 (2012)), they remain only poorly characterized and are notsuitable to initial high-throughput stages of drug screening. Incontrast, using a zebrafish scn1Lab mutant with greater than 75%sequence identity for a human sodium channel mutation, a large-scaletranscriptomic profiling of over 44,000 probes was completed,demonstrated a developmental progression of scn1Lab channel expressionand epileptic phenotypes, analyzed the effects of availableantiepileptic therapies, and screened a 320 compound chemical libraryagainst spontaneous unprovoked seizures. Although this firstproof-of-principle screen was accomplished at one fish per well, 6 to 12fish per trial and one trial per week, the ease with which zebrafishcould be scaled upward (especially in a commercial setting) to studyhundreds to thousands of larvae per week make this an attractive systemfor a rapid large-scale first-stage in vivo drug discovery program.Simultaneous in vivo evaluation of toxicity—one of the greatest sourcesof failure in moving lead compounds from the bench to the clinic—is acritical advantage of this approach over available organotypichippocampal culture- or in silica-based screening strategies.

Although any animal model drug discovery data should be treatedcautiously, clemizole, a compound with H1 antagonist and NS4B RNAinhibiting properties, is an FDA-approved drug with a safe toxicologyprofile emerged from this screen and offers an exciting starting pointfor further research. For example, although it was recently recognizedthat antihistamines inhibit induced seizures in neonatal rats (Yamada,K., Takizawa, F., Tamura, T., & Kanda T., The effect of antihistamineson seizures induced by increasing-current electroshocks: ketotifen, butnot olopatadine, promotes the seizures in infant rats. Biol. Pharm.Bull. 35, 693-697 (2012)), without being bound by any particular theory,this is likely not the mechanism of action here. We demonstrated fourother H1 antihistamines (pimethixene maleate, chloropyramine HCl,mebhydrolin napthalenesulfonate and iproheptine) failed to suppressconvulsive behavior in scn1Lab mutants. Furthermore, evidence suggeststhe potential for H1 antihistamines to adversely modify seizures inchildren (Miyata, I., Saegusa, H., & Sakurai, M., Seizure-modifyingpotential of histamine H1 antagonists: a clinical observation. Pediatr.Int. 53, 706-708 (2011)) indicating that more detailed analysis will berequired to identify a mechanism of action. Given that clemizole wasalso effective in a zebrafish version of the Metrazol test it may beworthwhile to pursue additional pre-clinical testing in theNIH-sponsored Anticonvulsant Drug Development Program at the Universityof Utah. Most importantly, these studies suggest that in vivo drugscreening and experimental analysis of scn1Lab mutant zebrafish couldprove extremely valuable to understanding (and treatment) of Dravetsyndrome.

Animals.

Scn1Lab (didy^(s552)) zebrafish embryos were a kind gift from HerwigBaier. Adult HuC:GFP zebrafish were a kind gift from Stephen Ekker.Zebrafish were generated and maintained in accordance with theguidelines of the University of California, San Francisco Committee onthe Use and Care of Animals. Zebrafish larvae were maintained in “embryomedium” consisting of 0.03% Instant Ocean (Aquarium Systems, Inc.,Mentor, Ohio, U.S.A.) in deionized water containing 0.002% MethyleneBlue as a fungicide. Larval zebrafish clutches were bred from scn1Labheterozygous animals that had been backcrossed to TL wild-type orHuC:GFP zebrafish for at least 7 generations. Homozygous mutants (sortedbased on pigmentation) and age-matched sibling larvae were used.Although the precise genetic defect responsible for the skinpigmentation issue is unknown, it is interesting that a 1.5-foldup-regulation of a gene encoding the melanocortin 5a receptor was notedin the microarray data.

Seizure Monitoring.

Procedures for locomotion tracking and electrophysiology were described(Baraban, S. C., et al., A large-scale mutagenesis screen to identifyseizure-resistant zebrafish. Epilepsia 48, 1151-157 (2007); Baraban, S.C., Taylor, M. R., Castro, P. A., & Baier H., Pentylenetetrazole inducedchanges in zebrafish behavior, neural activity and c-fos expression.Neuroscience 131, 759-768 (2005)). In pilot experiments, HuC:GFPzebrafish were used in electrophysiology experiments to obtain anestimation of the location of recording electrodes. Locomotion plotswere obtained for one fish per well at a recording epoch of 10 min usinga DANIOVISION® system running ETHOVISION® XT software (NoldusInformation Technology; Leesburg, Va.). Seizure scoring was performed asdescribed (Baraban, S. C., Taylor, M. R., Castro, P. A., & Baier H.,Pentylenetetrazole induced changes in zebrafish behavior, neuralactivity and c-fos expression. Neuroscience 131, 759-768 (2005)).Locomotion plots were analyzed for distance traveled (in mm) and meanvelocity (in mm/sec). Epileptiform events were analyzed in PCLAMP™(Molecular Devices; Sunnyvale, Calif.) and defined as upward or downwardmembrane deflections greater than 2× baseline noise level and classifiedas either interictal-like (100 to 300 msec duration) or ictal-like (1000to 5000 msec duration). Burst frequency was determined by counting thenumber of epileptiform events per minute during a 10-min recordingepoch. Burst duration was determined by measuring the onset-to-offsetinterval for all events during the same epoch.

Drugs were obtained from Sigma-Aldrich and dissolved in embryo media.Stock solutions were prepared in embryo media at 1 mM and pH adjusted to˜7.5. Ganaxolone was a kind gift from BioCrea GmbH (Radebeul, Germany).Compounds for drug screening were purchased from MicroSource DiscoverySystems, Inc. (International Drug Collection; Gaylordsville, Conn.) andwere provided as 10 mM DMSO solutions. Test compounds were dissolved inembryo media and tested at concentrations between 6.7 and 667 μM; finalDMSO concentration ˜7%. An initial screen concentration of 667 μM waschosen for behavioral studies in freely swimming fish as this falls onthe lower range of AED concentrations previously reported in to beeffective against PTZ (10-20 mM) induced seizures in larval zebrafish(0.1 to 25 mM) Baraban, S. C., Taylor, M. R., Castro, P. A., & Baier H.,Pentylenetetrazole induced changes in zebrafish behavior, neuralactivity and c-fos expression. Neuroscience 131, 759-768 (2005);Berghmans, S., Hunt, J., Roach, A., & Goldsmith, P., Zebrafish offer thepotential for a primary screen to identify a wide variety of potentialanticonvulsants. Epilepsy Res. 75, 18-28 (2007); Afrikanova, T., et al.,Validation of the zebrafish pentylenetetrazol seizure model: locomotorversus electrographic responses to antiepileptic drugs. PLoS One 8,e54166 (2013)) and was the most efficient use of the small volume ofstock solution (250 μL) provided by MicroSource Discovery Systems, Inc.A slightly higher concentration (1 mM) was chosen for the initial AEDvalidation assays in FIGS. 5A-5F and 6A-6E to account for any potentialcomplications associated with diffusion through the agar. DMSO wasevaluated for toxicity at dilutions between 0.01 and 100% usingwild-type larvae (n=12 fish per concentration); DMSO at >25% was lethal.

In all drug screening studies compounds were coded and experiments wereperformed by investigators blind to the nature of the compound. Baselinerecordings of seizure activity were obtained from mutants bathed inembryo media; a second plot was then obtained following a solutionchange to a test compound. Each test compound classified as a “positivehit” in the locomotion assay was visually confirmed as alive based onmovement in response to touch and visible heartbeat. WT fish exhibitlittle to no spontaneous swim activity during these 10 min recordingepochs (see FIG. 3B) and were not used in the drug discovery assay.

Procedures for microarray, quantitative PCR and whole-mount in situhybridization were described (Hortopan, G. A., et al., Spontaneousseizures and altered gene expression in GABA signaling pathways in amind bomb mutant zebrafish. J. Neurosci. 30, 13718-13728 (2010)).

Data are presented as mean and SEM, unless stated otherwise. Pairwisestatistical significance was determined with Student's two-tailedunpaired t-test, ANOVA or Mann-Whitney rank sum test, as appropriate,unless stated otherwise. Results were considered significant at P<0.05,unless otherwise indicated.

Example 2

Based on our previous discussion and some activity observed at the 100and 300 mg/kg doses in the qualitative MES screen in mice, we proceededwith quantitative testing in the MES/scMET/Tox mouse model to determinethe ED50/TD50. During the determination of the TPE in the MES model, noactivity was observed at the 300 mg/kg starting dose. However, activitywas observed at the 500 mg/kg dose with 2/4 animals protected at 0.25min and 4/4 animals protected at 30 minutes. No activity or toxicity(unable to grasp rotorod) was observed at any other dose or time pointtested. No activity was observed in the scMET model. The data in the MESmodel shows that there is significant activity/protection with ASP469016in this mouse model with an ED50<400 mg/kg.

Anticonvulsant Screening Results—Mice IP Quantification

ASP ID: 469016  Screen ID: 1  Sponsor ID: 642  Sponsor Class: ASP/CMSponsor Solvent Code: MC Slovent Prep: M&P, TW Animal Weight: −g DateStarted: 06-May-2014 Date Completed: 09-May-2014 Reference: 503: 294,297.509: 3, 4. ED50 Value Test Time (Hrs) ED50 95% Confidence IntervalSlope STD Err PI Value MES 0.5 <400.0 — SCMET 0.5 >250.0 — TOX0.5 >500.0 — ED50 Biological Response Test Time (hr) Dose (mg/kg) DthsN/F C MES 0.50 350 0/8 MES 0.50 400 7/8 MES 0.50 500 4/4 SCMET 0.50 2000/8 SCMET 0.50 250 0/4 TOX 0.50 500 0/4 Note: Presence of an asterisk(*) indicates that there are multiple comment codes. Time to Peak EffectTime (Hours) 0.25 0.5 1.0 2.0 4.0 6.0 8.0 24 3.0 Test Dose Dths N/F CN/F C N/F C N/F C N/F C N/F C N/F C N/F C N/F C MES 300 0/4 0/4 0/4 0/40/4 / / / / MES 500 2/4 4/4 0/4 0/4 0/4 / / / / TOX 400 0/8 0/8 / / / // / / TOX 500 0/4 0/4 0/4 / / / / / / Note: N/F = number of animalsactive or toxic over the number tested. C = Comment code. Presence of anasterisk (*) indicates that there are multiple comment codes. Commentsto NIH: Comments to Supplier: MES doses 350 m/kg and 400 m/kg and Scmetdose 200 m/kg were done with the On batch and all the other doses weredone with the A batch Insufficient material to continue further testing.

Example 3

ASP469016 was tested in our initial T31 (MES/scMET/Tox) screen at 30,100, and 300 mg/kg. The data for each condition is presented as N/F,where N equals the number of animals protected and F equals the numberof animals tested. For tests of toxicity (TOX), N equals the number ofanimals displaying toxic effects and F equals the number of animalstested. Codes in the C column refer to comments from the techniciansperforming the experiment and are defined in the comments section ifnecessary. Any deaths are noted. As shown in the 6 Hz (32 mA) model only1/4 animals were protected at 100 mg/kg at 30 min. In the MES-inducedseizure model only 1/4 animals were protected at 100 and 300 mg/kg at 30min. No toxicity (unable to grasp rotorod) or activity was detected atany other dose or time point tested.

Anticonvulsant Screening Results—Mice MES and 6 Hz Identification

ASP ID: 469016  U  Screen ID: 1  Sponsor ID: 642  Sponsor Class: ASP/CMSponsor Solvent Code: MC Slovent Prep: M&P, SB Route Code: IP AnimalWeight: −g 6 Hz 32 Date Started: 11-Feb-2014 Date Completed: 11-Feb-2014Current (mA): Reference: 503:153. Response Time (Hours) 0.5 2.0 0.25 1.04.0 6.0 3.0 8.0 24 Test Dose Form Dths N/F C N/F C N/F C N/F C N/F C N/FC N/F C N/F C N/F C 6 HZ 30 0/4 0/4 / / / / / / / 6 HZ 100 1/4 0/4 / / // / / / 6 HZ 300 0/4 0/4 / / / / / / / MES 30 0/4 0/4 / / / / / / / MES100 1/4 0/4 / / / / / / / MES 300 1/4 0/4 / / / / / / / TOX 30 SUS 0/80/8 / / / / / / / TOX 100 SUS 0/8 0/8 / / / / / / / TOX 300 SUS 0/8 0/8/ / / / / / / Note: N/F = number of animals active or toxic over thenumber tested. C = Comment code. Presence of an asterisk (*) indicatesthat there are multiple comment codes.

IV. EMBODIMENTS Embodiment P1

A method of treating an epileptic disorder, said method comprisingadministering to a subject in need thereof, a therapeutically effectiveamount of clemizole, an analog thereof or a pharmaceutically acceptablesalt thereof.

Embodiment P2

The method of embodiment P1, wherein said epileptic disorder is DravetSyndrome.

Embodiment P3

The method of any one of embodiments P1 to P2, wherein said clemizoleinhibits compulsive behaviors or electrographic seizures.

Embodiment P4

The method of any one of embodiments P1 to P3, wherein said clemizole isadministered as a pharmaceutical composition.

Embodiment 1

A method of treating an epilepsy disorder, said method comprisingadministering to a subject in need thereof, a therapeutically effectiveamount of clemizole, a clemizole analog, or a pharmaceuticallyacceptable salt thereof.

Embodiment 2

The method of embodiment 1, wherein said epilepsy disorder is DravetSyndrome, Lennox-Gastaut Syndrome, infantile spasm, or OhtaharaSyndrome.

Embodiment 3

The method of any one of embodiments 1 to 2, wherein said epilepsydisorder is Dravet Syndrome.

Embodiment 4

The method of any one of embodiments 1 to 3, wherein said epilepsydisorder is a pediatric epilepsy disorder.

Embodiment 5

The method of any one of embodiments 1 to 4, wherein said clemizole,said clemizole analog, or said pharmaceutically acceptable salt thereofinhibits compulsive behaviors or electrographic seizures in an epilepsysubject, a Alzheimer's disease subject, autism subject, or Parkinson'sdisease subject.

Embodiment 6

The method of any one of embodiments 1 to 5, wherein said administrationof said clemizole, said clemizole analog or said pharmaceuticallyacceptable salt thereof reduces the incidence of unprovoked seizures insaid subject in the absence of said clemizole, said clemizole analog, orsaid pharmaceutically acceptable salt thereof.

Embodiment 7

The method of any one of embodiments 1 to 6, wherein said administrationof said clemizole, said clemizole analog or said pharmaceuticallyacceptable salt thereof reduces or prevents myoclonus seizures or statusepilepticus in said subject in the absence of said clemizole, saidclemizole analog, or said pharmaceutically acceptable salt thereof.

Embodiment 8

The method of any one of embodiments 1 to 7, wherein said subject has aketogenic diet.

Embodiment 9

The method of any one of embodiments 1 to 8, wherein said clemizole,said clemizole analog, or said pharmaceutically acceptable salt thereofis administered to said subject at an amount of about 0.1 mg to about1000 mg per kg body weight.

Embodiment 10

The method of any one of embodiments 1 to 9, wherein said clemizole,said clemizole analog, or said pharmaceutically acceptable salt thereofis administered to said subject in a daily dose of about 0.1 mg to about1000 mg per kg body weight to said subject.

Embodiment 11

The method of any one of embodiments 1 to 10, wherein saidpharmaceutically acceptable salt is clemizole HCl.

Embodiment 12

The method of any one of embodiments 1 to 11, wherein said clemizole,said clemizole analog, or said pharmaceutically acceptable salt thereofis co-administered with an anti-epileptic drug (AED).

Embodiment 13

The method of embodiment 12, wherein said AED is acetazolamide,benzodiazepine, cannabadiols, carbamazepine, clobazam, clonazepam,eslicarbazepine acetate, ethosuximide, ethotoin, felbamate,fenfluramine, fosphenytoin, gabapentin, ganaxolone, huperzine A,lacosamide, lamotrigine, levetiracetam, nitrazepam, oxcarbazepine,perampanel, piracetam, phenobarbital, phenytoin, potassium bromide,pregabalin, primidone, retigabine, rufinamide, sodium valproate,stiripentol, tiagabine, topiramate, vigabatrin, or zonisamide.

Embodiment 14

The method of embodiment 13, wherein said AED is valproic acid,valproate, clonazepam, ethosuximide, felbamate, gabapentin,carbamazepine, oxcarbazepine, lamotrigine, levetiracetam,benzodiazepine, phenobarbital, pregabalin, primidone, tiagabine,topiramate, potassium bromide, phenytoin, stiripentol, vigabatrin, orzonisamide.

Embodiment 15

The method of embodiment 14, wherein said AED is valproic acid,valproate, Gabapentin, topiramate, carbamazepine, oxcarbazepine, orvigabatrin.

Embodiment 16

The method of embodiments 12 to 15, wherein said AED is administeredsimultaneously with or sequentially with said clemizole, said clemizoleanalog, or said pharmaceutically acceptable salt thereof.

Embodiment 17

The method of embodiments 1 to 16, wherein said clemizole, saidclemizole analog, or said pharmaceutically acceptable salt thereof isadministered as a pharmaceutical composition.

Embodiment 18

The method of claim 17, wherein said pharmaceutical composition furthercomprises a pharmaceutically acceptable excipient.

Embodiment 19

The method of any one of embodiments 17 to 18, wherein saidpharmaceutical composition comprises a therapeutically effective amountof said clemizole, said clemizole analog, or said pharmaceuticallyacceptable salt thereof.

Embodiment 20

The method of any one of embodiments 17 to 19, wherein saidpharmaceutically acceptable salt is clemizole HCl.

Embodiment 21

The method of any one of embodiments 17 to 19, wherein saidpharmaceutical composition is co-administered with an anti-epilepticdrug (AED).

Embodiment 22

The method of embodiment 21, wherein said AED is acetazolamide,benzodiazepine, cannabadiols, carbamazepine, clobazam, clonazepam,eslicarbazepine acetate, ethosuximide, ethotoin, felbamate,fenfluramine, fosphenytoin, gabapentin, ganaxolone, huperzine A,lacosamide, lamotrigine, levetiracetam, nitrazepam, oxcarbazepine,perampanel, piracetam, phenobarbital, phenytoin, potassium bromide,pregabalin, primidone, retigabine, rufinamide, sodium valproate,stiripentol, tiagabine, topiramate, vigabatrin, or zonisamide.

Embodiment 23

The method of any one of embodiments 21 to 22, wherein saidpharmaceutical composition comprises clemizole, said clemizole analog,or said pharmaceutically acceptable salt thereof and an AED

Embodiment 24

The method of one of embodiments 21 to 23, wherein said pharmaceuticalcomposition comprises clemizole, said clemizole analog, or saidpharmaceutically acceptable salt thereof and an AED

Embodiment 25

A pharmaceutical composition comprising clemizole, a clemizole analog,or a pharmaceutically acceptable salt thereof for use in treating anepilepsy disorder.

Embodiment 26

The pharmaceutical composition of embodiment 25, wherein saidpharmaceutical composition is co-administered with an AED.

1. A method of treating an epilepsy disorder, said method comprisingadministering to a subject in need thereof, a therapeutically effectiveamount of clemizole, a clemizole analog, or a pharmaceuticallyacceptable salt thereof.
 2. The method of claim 1, wherein said epilepsydisorder is Dravet Syndrome, Lennox-Gastaut Syndrome, infantile spasm,or Ohtahara Syndrome.
 3. The method of claim 1, wherein said epilepsydisorder is Dravet Syndrome.
 4. The method of claim 1, wherein saidepilepsy disorder is a pediatric epilepsy disorder.
 5. The method ofclaim 1, wherein clemizole, said clemizole analog, or saidpharmaceutically acceptable salt thereof inhibits compulsive behaviorsor electrographic seizures in an epilepsy subject, an Alzheimer'sdisease subject, an autism subject, or a Parkinson's disease subject. 6.The method of claim 1, wherein said administration of clemizole, saidclemizole analog or said pharmaceutically acceptable salt thereofreduces the incidence of unprovoked seizures in said subject whencompared to the absence of clemizole, said clemizole analog, or saidpharmaceutically acceptable salt thereof.
 7. The method of claim 1,wherein said administration of clemizole, said clemizole analog or saidpharmaceutically acceptable salt thereof reduces or prevents myoclonusseizures or status epilepticus in said subject when compared to theabsence of clemizole, said clemizole analog, or said pharmaceuticallyacceptable salt thereof.
 8. The method of claim 1, wherein said subjecthas a ketogenic diet.
 9. The method of claim 1, wherein clemizole, saidclemizole analog, or said pharmaceutically acceptable salt thereof isadministered to said subject at an amount of about 0.1 mg to about 1000mg per kg body weight.
 10. The method of claim 9, wherein clemizole,said clemizole analog, or said pharmaceutically acceptable salt thereofis administered to said subject in a daily dose of about 0.1 mg to about1000 mg per kg body weight to said subject.
 11. The method of claim 1,wherein said pharmaceutically acceptable salt is clemizole HCl.
 12. Themethod of claim 1, wherein clemizole, said clemizole analog, or saidpharmaceutically acceptable salt thereof is co-administered with ananti-epileptic drug (AED).
 13. The method of claim 1, wherein clemizole,said clemizole analog, or said pharmaceutically acceptable salt thereofis an adjunctive therapy with an anti-epileptic drug (AED).
 14. Themethod of claim 12, wherein said AED is acetazolamide, benzodiazepine,cannabadiols, carbamazepine, clobazam, clonazepam, eslicarbazepineacetate, ethosuximide, ethotoin, felbamate, fenfluramine, fosphenytoin,gabapentin, ganaxolone, huperzine A, lacosamide, lamotrigine,levetiracetam, nitrazepam, oxcarbazepine, perampanel, piracetam,phenobarbital, phenytoin, potassium bromide, pregabalin, primidone,retigabine, rufinamide, sodium valproate, stiripentol, tiagabine,topiramate, vigabatrin, or zonisamide.
 15. The method of claim 14,wherein said AED is valproic acid, valproate, clonazepam, ethosuximide,felbamate, gabapentin, carbamazepine, oxcarbazepine, lamotrigine,levetiracetam, benzodiazepine, phenobarbital, pregabalin, primidone,tiagabine, topiramate, potassium bromide, phenytoin, stiripentol,vigabatrin, or zonisamide.
 16. The method of claim 15, wherein said AEDis valproic acid, valproate, Gabapentin, topiramate, carbamazepine,oxcarbazepine, or vigabatrin.
 17. The method of claim 12, wherein saidAED is administered simultaneously with or sequentially with saidclemizole, said clemizole analog, or said pharmaceutically acceptablesalt thereof.
 18. The method of claim 1, wherein clemizole, saidclemizole analog, or said pharmaceutically acceptable salt thereofcomprises a pharmaceutical composition.
 19. The method of claim 18,wherein said pharmaceutical composition further comprises apharmaceutically acceptable excipient.
 20. The method of claim 18,wherein said pharmaceutical composition comprises a therapeuticallyeffective amount of clemizole, said clemizole analog, or saidpharmaceutically acceptable salt thereof.
 21. The method of claim 20,wherein said pharmaceutically acceptable salt is clemizole HCl.
 22. Themethod of claim 20, wherein said pharmaceutical composition isco-administered with an anti-epileptic drug (AED).
 23. The method ofclaim 22, wherein said AED is acetazolamide, benzodiazepine,cannabadiols, carbamazepine, clobazam, clonazepam, eslicarbazepineacetate, ethosuximide, ethotoin, felbamate, fenfluramine, fosphenytoin,gabapentin, ganaxolone, huperzine A, lacosamide, lamotrigine,levetiracetam, nitrazepam, oxcarbazepine, perampanel, piracetam,phenobarbital, phenytoin, potassium bromide, pregabalin, primidone,retigabine, rufinamide, sodium valproate, stiripentol, tiagabine,topiramate, vigabatrin, or zonisamide.
 24. The method of claim 22,wherein said pharmaceutical composition comprises clemizole, saidclemizole analog, or said pharmaceutically acceptable salt thereof andan AED.
 25. A pharmaceutical composition comprising clemizole, aclemizole analog, or a pharmaceutically acceptable salt thereof for usein treating an epilepsy disorder.
 26. The pharmaceutical composition ofclaim 25, wherein said pharmaceutical composition is co-administeredwith an AED.